Notification of Hospital Discharge Appeal Notices

CMS has finalized and released the Notification of Hospital Discharge Appeal Rights and The Important Message from Medicare. Hospitals had to begin using these versions on July 2, 2007.

Download the forms and instructions on CMS’ Web site (check this site often for updates). The forms are downloadable Word documents, which means you may customize them for your hospital. Please note that on pages 1 and 2 of The Important Message from Medicare, you must insert the QIO and its contact information. Please insert Quality Insights of Pennsylvania and the phone number 1-800-322-1914.

To download these forms with Quality Insights’ information already inserted, click on the form below:
· The Important Message from Medicare 
· Detailed Notice of Discharge 

Please designate a Hospital Discharge Appeals Contact by completing and returning the Change of Contact Form.