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MEDICARE

Medicare Beneficiary Protection Program

NDHCRI is committed to improving the lives of people with Medicare, not only by ensuring good medical care, but also by serving as an advocate and information resource. Select one of the following topics to see how NDHCRI can provide information and education:

Benefits Improvement and Protection Act (BIPA)  

Please follow this link for updates effective 07/28/05.  Update
Beginning July 1, 2005, Home Health Agencies, Skilled Nursing Facilities, Comprehensive Outpatient Rehabilitation Facilities, Swing Beds and Hospices with beneficiaries in Original Medicare will be required to notify beneficiaries of their right to a new expedited review process when these providers anticipate that Medicare coverage of their services will end.  For more information follow this link BNI information.  Questions regarding the new expedited review process may be e-mailed to bipaexpeditedreviews@cms.hhs.gov.

Summary of Notification Requirements for FFS Expedited Determination
Flowchart of BIPA Review Process
Please follow this link to access previous educational events related to BIPA.

Please follow this link to fill out your facility's contact information. Benefits Improvement and Protection Act (BIPA) Contact Information.

Notification of Hospital Discharge Appeal Rights - Update on CMS-4105-F 

CMS has created a webpage on cms.hhs.gov where information and updates on the revised notification process have been posted including notices and instructions.  The link is http://www.cms.hhs.gov/BNI/12_HospitalDischargeAppealNotices.asp#TopOfPage.

CMS continually updates the Q&As on this website.  Providers should check the website often for updates.

Federal Register - Final Rule for Notification of Hospital Discharge Appeal Rights

Guidance from CMS on Notification of Hospital Discharge Appeal Rights
Follow this link to a powerpoint presentation created by CMS about Hospital Discharge Appeal Rights

Hospital Discharge Notice Provider Training
An educational session is being provided by the Beneficiary Protection Program Quality Improvement Organization Support Center, TMF Health Quality Institute entitled "Notification of Hospital Discharge Appeal Rights: Provider and QIO Responsibilities".  To access this recorded webex follow this link, go the upper right corner and click on "View Event Recordings" then once on this page, scroll down to "TX - HINN Provider Training".  Educational Session

NDHCRI letter templates for Hospital Discharge Reviews
Please follow this link to access the Letter Templates that NDHCRI will be using for notifications related to the Hospital Discharge Appeals.

Beneficiary Notice of Liability      *temporary form as of 07/25/07*
This template is an interim form for HINN 12 that may be used until CMS releases their final version.

Contact Form
It is very important for each facility to fill out this form and return it to NDHCRI as soon as possible.  We need to be able to locate the contact person or department when an appeal has been requested by a beneficiary or their representative.  The inability to reach a contact person at your facility could incur further liability for your facility.

Please fill out this Contact Form and fax to NDHCRI.

For your convenience here are the contact numbers for NDHCRI:
Medicare Beneficiary Helpline
        1-800-472-2902 (In State)
        1-888-472-2902 (Out of State)
    NDHCRI Fax    1-701-838-6009

List of documents
to be submitted to NDHCRI to complete the appeal/review.

Hospital Discharge Notice Review Process

Who is authorized by law to make health care decisions?
Authorized Representative North Dakota's Century Code
Follow this link to the North Dakota Century Code statement which can be found on pages 17 and 18 of this document.

Hospital Payment Monitoring Review Program (HPMP)

Special Project: Admissions with three day or less length of stay
HPMP Resources
HPMP Compliance workbook
HPMP QIO Support Contractor Resources
HPMP FOCUS_PDSA

Beneficiary Complaint Response Program

Mediation

Program for Evaluating Payment Patterns Electronic Report (PEPPER)
Please follow this link for information about PEPPER.
This link will lead you to more resources.  PEPPER resources
Look to the Calendar of Events for future training sessions.


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