Important Message from Medicare Not Clear

CMS’s IMM sends mixed messages to providers.

The Important Message from Medicare (IMM) has changed significantly in its latest reiteration, and the IMM now must be presented to both Medicare and Medicare Advantage patients, according to Ronald Hirsch, MD, who explained during Monday’s edition of Monitor Mondays that both patient types can call their Quality Improvement Organization(QIO)  if they want to appeal their discharge.  

Yet, for some reason, according to Hirsch, the Centers for Medicare & Medicaid Services (CMS) decided, 13 years after the IMM was released, that the form now needs the name and phone number of the Medicare Advantage (MA)  plan on it, in case the Medicare Advantage patient misses the deadline to file a QIO appeal.

Hirsch noted that in his area (Kane County, Illinois), 13 insurers offer 40 different plans, and he asked CMS if the exact name of the plan must go on the form (and also which phone number is required to be on the form).

“Only a general carrier name is needed,” responded a CMS representative when queried by Hirsch, who noted during the broadcast that most MA cards have at least three phone numbers on the back – and the web page for the insurer has completely different numbers.

“One case manager in Ohio asked CMS, and CMS replied, “the expectation is only that a usable plan phone number be included, not a specific appeals number,” said Hirsch. “A New York case manager posted that she never found even one insurance company that knew what the patients were talking about when they called for a discharge appeal. Is a phone number considered usable if the person who answers doesn’t know what to do?”

“I have also talked to several hospitals where the registration system prints out the (IMM) when the admission order is placed, but they have no idea if the system can be modified to include the payor name and number, and are afraid to submit a request to IT knowing there is a six-month backlog of projects, (knowing) they’ll be laughed out of the room if they tell them the deadline is March 31.”

Hirsch went on to explain that he voiced his concerns to CMS, telling the agency that he felt its submission for approval was defective because CMS estimated that the changes would impose no additional burden on providers. Hirsch said CMS told him that “we removed more fields from the Important Message from Medicare than we added. This is why there was no net change in burden.”

“So they took off the area for the physician name and hospital information, and they think that balances with having to add the Medicare Advantage plan name and correct phone number?” Hirsch asked. “I don’t think so. Nonetheless, it’s time to  get working on your processes.”

Programming Note: Listen to live reports from Dr. Hirsch on Monitor Mondays, 10-10:30 a.m. EST.