If you want to communicate BFCC-QIO information, please email Acentra Health at QIOCommunications@acentra.com and request a newsletter insert or fact sheet for your organization. Please do not copy and paste information from Case Review Connections.

in this issue:

• Medical Director's Corner
• Rural-Urban Disparities in Health Care in Medicare
• CMS Quality Conference
• Resources to Help You Share Medicare Rights Information
• February Health Observance - American Heart Month
• March Health Observance - Patient Safety Awareness Week
• Feedback
• SNF Criteria Podcast

medical director's corner - jessica whitley, md, mba

A NEW APPEAL TYPE: HOSPITAL OBSERVATION APPEALS

Background

An order from the U.S. District Court for the District of Connecticut in Alexander v. Azar (613 F. Supp. 3d 559, D. Conn. 2020), affirmed by the Second Circuit in Barrows v. Becerra (24 F.4th 116, 2d Cir. 2022), required the Centers for Medicare & Medicaid Services (CMS) to establish an appeals process for certain Medicare beneficiaries. These appeals apply to patients initially admitted as inpatients but later reclassified as outpatients receiving observation services. Known as Hospital Observation Appeals, the regulations were finalized in the Federal Register on October 15, 2024, (89 FR 83240) under 42 C.F.R. §§405.1210–1212 and 42 C.F.R. 476.71(a)(9).

Starting February 14, 2025, Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) will accept and review these appeals.

Which patients are eligible for this appeal?

The expedited determination process is available to beneficiaries in Fee-for-Service Medicare (also referred to as Original Medicare) who meet the following criteria:

1. Reclassification while hospitalized: Beneficiaries must have been formally admitted as inpatients and then reclassified as outpatients receiving observation services.
2. Medicare Part B coverage:
• If the beneficiary has Medicare Part B, their hospital stay must last at least three days to qualify.
• For those without Medicare Part B, no minimum hospital stay is required.

Hospitals are required to issue written notice of the beneficiary's appeal rights using the Medicare Change of Status Notice (MCSN) (CMS 10868).

MCSN Delivery Requirements

1. Timing:
• Deliver the MCSN as soon as eligibility is established and no later than four hours before discharge.
• For Part B beneficiaries, deliver the notice promptly after reclassification and upon reaching the third day of the hospitalization.
• For non-Part B beneficiaries, deliver the notice immediately after reclassification.
2. Content: The MCSN must include:
• Details of the status change and appeal rights under §405.1211.
• Implications of the status change, including potential cost adjustments and Medicare coverage for skilled nursing facility services.
• Any additional information required by CMS.
• Please note: The MCSN must remain two pages (one double-sided page or two single-sided pages).

Electronic and Remote MCSN Delivery

Hospitals may issue the MCSN electronically and use assistive devices for obtaining signatures. For representatives not physically present:

• Notify the representative via telephone, with the call date/time considered the receipt date.
• Mail the MCSN after the call and document the following in the “Additional Information” section:
  • Date/time of the call;
  • Name of the staff member making the call and the representative contacted; and
  • Contact details and notes confirming verbal communication of the MCSN’s content.

Hospitals must demonstrate timely contact attempts and proper delivery of the MCSN.

To access notices for the new observation appeals, go to www.cms.gov/bni and choose FFS MCSN.

You can also visit our appeals page for more information and web links.

rural-urban disparities in health care in medicare

This November 2024 report provides a nationwide summary of the quality of health care received by Medicare beneficiaries. It is divided into three sections: (1) rural-urban differences in healthcare experiences and clinical care; (2) variations in these differences by race and ethnicity; and (3) historical trends in quality of care for rural and urban residents.

The first two sections focus on quality-of-care data reported in 2023 while the third section examines trends using data from 2017 to 2023.

cms quality conference 

The CMS Quality Conference will be held March 17-19, 2025, in Baltimore, Maryland, in person or virtually. This year's theme is Elevating Quality - Advancing Optimal Health for Individuals, Families, Caregivers, Clinicians, and Communities. You can learn more about:

• Collecting and Using Quality Data – Leveraging data to drive better healthcare outcomes.
• Collaborating with Partners and Communities – Strengthening relationships for collective impact.
• Understanding Patient and Caregiver Perspectives – Ensuring voices are heard and needs are met.
• New Technology and Innovations – Exploring advancements that transform health care.

Registration is now available.

resources to help you share medicare rights information

Visit our Advocacy Resources page for materials to help you share Medicare rights information with Medicare beneficiaries in your community.

One example of materials available is flyers, which are available in both English and Spanish. This flyer includes information about Acentra Health's free services for people who have Medicare.

february health observance - american heart month

February is the month when we focus on heart health. Visit our American Heart Month page for information that you can share with your patients and communities.

march health observance - patient safety awareness week

Patient Safety Awareness Week is observed from March 9 to March 15, 2025.

This brings an opportunity to raise awareness about patient safety issues and recognize staff for the completion of successful projects. The Institute for Healthcare Improvement has information and resources available, including a webinar on Diagnostic Excellence.

feedback

We value your feedback. Please let us know if there is any content that you would like to see covered in our stakeholder/provider newsletter by emailing QIOCommunications@acentra.com.

Publication No. R146810-126-2/2025. This material was prepared by Acentra Health, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.