Hospital Discharge Appeal Notices
Hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the Detailed Notice of Discharge (DND) from the hospital or their Medicare Advantage plan, if applicable. These requirements were published in a final rule, CMS-4105-F: Notification of Hospital Discharge Appeal Rights, which became effective on July 2, 2007. The final rule and IM issuance guidelines (Manual Instructions) are posted below under “Downloads”.
August 2014 – IMPORTANT: UPDATING MEDICARE NOTICES WITH NEW QIO INFORMATION
Providers, suppliers, Medicare Advantage Organizations and Prescription Drug Plans should update their Medicare notices with the correct Quality Improvement Organization (QIO) contact information as quickly as possible and no later than September 1, 2014. Please see http://www.qioprogram.org/ for QIO details.
The latest versions of the Important Message from Medicare (IM), Form CMS-R-193, and the Detailed Notice of Discharge (DND), Form CMS-10066, are posted below under “Downloads”. These notices remain unchanged from the 07/10 approved versions and are effective until 7/31/2016. Issuance guidelines can be found in the Manual Instructions download below.
Note: The Notice of Hospital Requested Review (HRR), also known as HINN 10, has been relocated to the HINN web page and can be accessed by clicking on the "HINNs" link below.
- Important Message from Medicare - English and Spanish [ZIP, 110KB]
- Detailed Notice of Discharge - English and Spanish [ZIP, 59KB]
- CMS-4105 Manual Instructions [ZIP, 47KB]
- CMS-4105-F Notification of Hospital Discharge Appeal Rights Final Rule [PDF, 173KB]
- CMS-4105-CN: Correction Notice 1-26-2007 [PDF, 43KB]
- Resource 04-03-07 [PDF, 84KB]
- Resource 07-02-07 (Revised 8/21/07) [PDF, 78KB]
- Page last Modified: 08/14/2014 12:21 PM
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