Benefits Improvement and Protection Act notices can be found on the Beneficiary Notices Initiative page with the FFS ED Notices. For more information, review the Fee for Service Expedited Determination (ED) Process PDF which includes questions and answers that pertain to beneficiaries who have Original Medicare. These appeals are similar to the ones for beneficiaries enrolled in a Medicare Advantage Plan.
Before providers terminate services, they need to give beneficiaries a written notice that care involving a skilled nursing facility, home health agency, comprehensible outpatient rehabilitation facility or hospice will be discontinued. Beneficiaries need to receive the notice two or more days before covered services are supposed to end.
If the beneficiary wants to appeal to Quality Insights, the provider needs to give the beneficiary a detailed notice listing the reasons why services are no longer covered. Quality Insights will need a copy of the beneficiary’s medical record, the initial notice and the detailed notice.
Learn More About BIPAQuality Insights offered BIPA training to providers in 2005. Recordings of these training sessions are available. The materials below were used for the BIPA training sessions.
- Benefits Improvement and Protection Act (BIPA) Reviews (PowerPoint)
- BIPA Timing of Notice Examples (Word)
- Appointment of Representative (PDF)