Updated Important Message from Medicare and Detailed Notice of Discharge

on Monday, 26 June 2017. All News Items | Case Management | Medicare Coverage

The Right Care, at the Right Time, at the Right Cost, in the Right Setting

As we approach the 4th of July Holiday it is a time to reflect on the history of our great nation. It is also a time to say a prayer of thanks and gratitude for all those who have served and continue to serve to protect the personal freedoms and rights guaranteed to us by the Bill of Rights.

While there has been much debate as to whether healthcare is a right, Medicare beneficiaries, Medicare Advantage (MA) plan enrollees, Medicare as a Secondary Payor (MSP), and dual-eligible beneficiaries who are hospital inpatients have long had a statutory discharge appeal right.

Effective July 1, 2007, hospitals were required to begin delivering a revised version of the Important Message from Medicare (IM) form informing Medicare beneficiaries about their appeal rights. This second form was and still is to be given within two days of discharge. Additionally, beneficiaries who choose to appeal a discharge decision must also be provided the Detailed Notice of Discharge (DND) form from the hospital or his/her Medicare Advantage plan, if applicable.

Frequently Asked Questions

Over time, MMP has received questions regarding the process for delivering the IM form. On April 3, 2007 CMS released a Q&A document that in general has answered specific IM questions posed to us by our clients. Below are two of the most frequently asked questions and a link to the entire CMS document.

Question: Are we required to provide the IM and DND forms to all patients, regardless of payment source?

Answer: “This rule applies to all Medicare beneficiaries, including enrollees in Medicare Advantage (MA) plans and other Medicare health plans subject to MA regulations. Section 1154 of the Social Security Act applies to all patients who are under Medicare, regardless of where Medicare falls in the sequence of payment. Thus, all Medicare beneficiaries, no matter where in the sequence of payers Medicare falls, must receive these notices.”

Question: “Does the follow-up copy of the IM need to be signed again? If the follow-up copy is delivered and the patient ends up staying several more days, does another follow up copy need to be delivered?”

Answer: “The regulations do not require that the follow-up copy be signed. It serves as a reminder of the information that was given on the initial IM. However, while the beneficiary’s signature is not required, a hospital must be able to document that the notice has been delivered. One way to accomplish this would be to have the beneficiary initial the form to indicate that he or she has received it. We intend to provide an “Additional Information” area for an entry on the latest version of the IM. If the follow-up copy of the IM has been delivered and a beneficiary remains in the hospital for more than 2 additional calendar days, another follow-up copy should be issued according to the required timeframes.”

CMS Document Final Rule: Notification of Hospital Discharge Appeal Rights (CMS-4105-F) Qs And As (April 3, 2007) at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/CMS4105FINALRULEQsandAs2007.pdf

Appeal Notice Updates Timeline

As mentioned earlier, on July 1, 2007 hospitals were required to begin delivering a second copy of the IM letter within two days of the beneficiaries discharge. Since that time there have been updates to the IM Form CMS-R-193 and DND Form CMS 10066 as outlined below.

July 2010 IM Form Update

In 2010 the OMB released an updated form approved 07/10 that added a place to put the time the letter was signed in addition to the date.

August 2014 QIO Contact Information Change

With the 11th Scope of Work for the Quality Improvement Organizations (QIOs), responsibilities were split into two separate QIOs. The Quality Innovation Network (QIN) QIOs and the Beneficiary and Family Centered Care (BFCC) QIOs. Hospital Discharge Appeals are managed by the BFCC-QIOs. With this change, in August of 2014, CMS required hospitals to update their forms with the correct BFCC-QIO contact information no later than September 1, 2014.

June 2017 Form Update

A few weeks ago on June 6th CMS posted updated IM and DND forms to their Hospital Discharge Appeal Notices webpage. Comparing the new forms to the previous forms, MMP only noted the following form updates:  

  • IM Form CMS-R-193:
    • At the bottom left corner of the first page “Form CMS-R-193 (approved 07/10)” has been changed to “Form CMS-R-193 (Exp. 03/31/2020), and
    • Above the “Additional Information” box on the bottom of page two the following verbiage has been added, “CMS does not discriminate in its programs and activities. To request this publication in an alternate format, please call: 1-800-MEDICARE or email: This email address is being protected from spambots. You need JavaScript enabled to view it..”
  • DND Form CMS 10066:
    • At the bottom of the form the following verbiage has been added, “CMS does not discriminate in its programs and activities. To request this publication in an alternative format, please call: 1-800-MEDICARE or email: This email address is being protected from spambots. You need JavaScript enabled to view it., and
    • At the bottom left corner for the form “CMS 10066 (approved 07/10)” has been changed to “CMS 10066 (Exp. 10/31/2019).”

Additional information about Hospital Discharge Appeals can be found at the following resources.

BFCC-QIO Appeals webpages

Medicare Claims Processing Manual, Chapter 30 – Financial Liability Protections, Section 200 – Expedited Review Process for Hospital Inpatients in Original Medicare at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c30.pdf

State Operations Manual, Appendix A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, §482.13(a)(1) at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf

Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Services at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth monitors, interprets and communicates current and upcoming Case Management / Clinical Documentation issues as they relate to specific entities concerning Medicare. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful

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