expedited appeal connection 1-2.pub - FMQAI

More documents

Recommendations

Info

How To Reissue a Notice After An Invalid NoticeThe process for correcting an invalid notice depends on whether the patient is a traditional MedicarePatient or a Managed Care enrollee.For FFS Traditional Medicare PatientsAn invalid notice must be reissued. A new notice of Medicare Provider Non-Coverage is to be given regardlessof which day the new notice is given. The effective date documented on the first notice remainsthe same on the reissued notice. However, an asterisk (*) is put in front of the date on the new notice.This asterisk corresponds to the paragraph that is inserted in the additional information section on thesecond page, which must state:• We are giving you another notice because the QIO decided the previous notice we gave you on (fillin the date prior generic notice was given) was invalid. You will not have to pay for any care youreceived until two days after you receive this notice. You must call the QIO again after receivingthis new notice if you still want the QIO to review the decision to end your Medicare coverage.Liability: The patient would incur no liability providing he/she left the facility or stopped outpatienttreatment two days after the new notice was issued, or the decision for discharge was overturned onappeal. The provide would incur liability for any time after the original effective date.For Managed Care Patients:A new notice is given and the effective date changes if the date of re-issue is after the first date the firstnotice was issued. The patient would be given a new effective date (two days after issuing the newnotice) and would need to call again if he/she wishes to appeal.For example: If the notice was given on 10/4 with an effective date of 10/6 and the notice was found tobe invalid, then after reissue on 10/5, the new effective date would be 10/7.
How To Reissue a Notice After An Invalid Notice (cont.)Liability: The patient would incur no liability providing he/she left the facility on the neweffective date or the decision for discharge was overturned on appeal. The Medicare Advantageplan would incur liability for any extra days of coverage beyond the original effective date.Due to the potential for liability for either the provider or the Managed Care Organization, it isessential that the provider understand the appeal process and the documentation required to assurethe notices are valid.For more information about this newsletter, contact:Marie Munsch - Case Review813-865-3909This material was prepared by FMQAI, the Medicare Quality Improvement Organization for Florida, under contract with the Centers forMedicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do notnecessarily reflect CMS policy. FL2009FONR0911164
Page 1 and 2: Expedited Appeal ConnectionEducatio
Page 3: Obtaining The Notices - www.cms.gov

expedited appeal connection 1-2.pub - FMQAI

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?