CMS-R-193 Comments #1,2 & 3

C

r 5 . 1 0 FOUNDATION
~~
FOR MEDICAL
CARE

aILLINOIS
FOUNDATION
FOR QUALITY
HEALTHCARE
.

6000 Westown Parkway West Des Moines, Iowa 50266-7771
WATS (800)383-2856. FAX (515)223-2141

January 19,2007

CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development - C
Attention: Bonnie L. Harkless
Room C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1 850
Dear Ms. Harkless:
This letter is our response to requests for public comment on the Revised Version of the
Important Message from Medicare.
The phrase "The QIO accepts requests for appeals 24 hours a day" may lead readers to
incorrectly assume that someone would be available to help them 24 hours a day.
Additionally, QIOs need clarification on CMS expectations regarding available methods
for beneficiary submission of appeal requests, e.g., voicemail, fax, e-mail, etc.
Thank you for the opportunity to submit comments in regards to the Important Message
from Medicare.
Sincerely,

Kim Downs, R.N., C.P.H.Q.
Senior Director, Medicare Beneficiary Protection Program

MEDI
CENTERSfor MEDICARE & MEDICAIDSERVICES

Part A Intermediar)
Part B Carrie1

/

New Number: (469) 372-0992
Fax Number: (469) 372-2649

January 12,2007
CMS, Office of Strategic Operations And Regulatory Affairs
Division of Regulations Development-C,
Attention: Bonnie L. Harkless
Room C4-26-05
7500 Security Boulevard
Baltimore, Maryland 21 244-1 850
RE: Comments on Revised Important Message from Medicare
CMS document identifier: CMS-R-193

OMB number: 0938-0692
Dear Ms. Harkless,
The Revised Important Message from Medicare should include an additional statement
that infonns the beneficiary that the hospital may unilaterally disregard the patient's rights based
on how the hospital chooses to bill the claim to Medicare.
Beginning October 12,2004, with the irilplementation of CR 3444, hospitals may change
the level of service for a patient from inpatient to outpatient should the Hospital's Utilization
Review committee determine that the level of service initially ordered by the physician is
incorrect. The Change Request does not specify that either the patient or the admitting physician
must agree with or even be infom~edof this determination. The hospital may indicate this change
in status on the claim by the use of Condition Code 44, provided that the change is made with
certain preconditions specified in the CR.
Since changing a patient's status changes the patient from one benefit (Part A) to another
benefit (Part B) with consequent changes in co-pays, deductibles, limitations on liability, and
appeal rights, and since this change in status usually occurs after the patient has been infonned of
their rights using this form (CMS-R-193), as required under the Conditions of Participation, it
might be prudent to add something to this document that the appeal rights do not apply if the
hospital unilaterally makes a change in status as permitted by CR 3444.
Thank you for the opportunity to comment.

~f~

arks E. Haley, MD, MS, FACP

l
Medicare ~ e d i c aDirector

1

cc: William Rogers, MD

TrailBlazer Health Enter rises, LLCSM

!'

Medicare Medical Direc or

Executive Center Ill

8330 LBJ Freeway Dallas, TX 75243-1213

P.O. Box 6601 56

Dallas, TX 75266-0156

A CMS Contracted Intermediary and Carrier

.

Oxford Senior Citizens, Inc.
922 Tollgate Drive, P.O. Box 381
Oxford, OH 45056
Phone: (5 13) 523-8 100, FAX: (5 13) 524-3 126

January 17,2007
CMS, Office of Strategic Operations and Regulatory Affairs
Divisions of Regulations Development - C
Attention Bonnie L. Harkless
Room C4-26-05
7500 Security Blvd.
Baltimore, MD 2 1244-1850
Dear Ms. Bonnie Harkless:

I am writing in regard to the public forum response request in regards to the Paperwork
Reduction Act issue of hospitals notifjlng patients of their right to appeal discharge. My
experience over the last 17 years as a Licensed Social Worker for the elderly population is the
Peer Review form is either not clearly explainedfpointed out, it is too long and of too small print,
the patient is too ill, or a combination there of for the patient to realize they have that right. I
have yet to meet a former older patient who knew they could have appealed their discharge
decision. I believe this fact needs to be taken into consideration when expected procedures are
being reviewed.
Your response to me may be that the patient signs the form. The vast majority of clients I have
worked with will sign about anything handed to them in a situation where they accepted what
was happening. I did assessments to accept clients into a county funded program to provide
home care services to the elderly for six years. I learned very early on that I needed to inform the
client what is in the document before allowing them to sign it. My personal experience is that
hospitals either give a one line explanation or none.
Thank you.
Sincerely,

Emilie Ratterman, lsw
Outreach