January 23, 2023 - The IM/DND have received OMB approval. The new versions must be used no later than April 27, 2023.
Hospitals are required to deliver the Important Message from Medicare (IM), formerly CMS-R-193 and now CMS-10065, 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. A Detailed Notice of Discharge (DND) is given only if a beneficiary requests an appeal. The DND explains the specific reasons for the discharge.
Full instructions for the Original Medicare, also known as Fee for Service (FFS), process are available in Section 200, of Chapter 30 of the Medicare Claims Processing Manual, available below in "Downloads".
Current versions of the Important Message from Medicare (IM), Form CMS-10065, and the Detailed Notice of Discharge (DND), Form CMS-10066, are posted below under "Downloads".
Full instructions for Medicare health plans are available in Section 100 of the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, available below in “Downloads.”
The notices, including Spanish versions, are available below under “Downloads.”
Questions?
Questions regarding the IM and DND can be submitted at: https://appeals.lmi.org
Downloads
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Important Message from Medicare - English and Spanish (Incl Large Print) (ZIP) -
Detailed Notice of Discharge - English and Spanish (Incl Large Print) (ZIP) -
Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance (PDF) -
Chapter 30 - Financial Liability Protections (PDF)