HINN/IM Review Medicare will only reimburse hospitals for medically necessary care, but Medicare has established a way for hospitals to bill beneficiaries who want to stay in the hospital regardless of medical necessity. In order for the beneficiary to be billed, hospitals must give proper notice. Proper notice comes in the form of Hospital Issued Notices of Noncoverage (HINNs) and Notices of Hospital Discharge Appeal Rights. Hospitals issue the notices of noncoverage when the provider believes there’s no medical reason to admit a Medicare beneficiary. If the beneficiary wants to stay in the hospital, the hospital gives them an Important Message (IM) and a Detailed Notice of Discharge.
Quality Insights will review the Hospital Issue Notices of Noncoverage and the Important Message appeals to make sure they follow Medicare policy. Quality Insights will decide whether a beneficiary can be admitted to the hospital. Quality Insights will reconsider the decision upon the beneficiary’s request.