Recommended Spanish equivalent
Aviso Important Message from Medicare sobre los derechos del paciente. Keep the official English form name and code when identifying the actual notice.
Plain-language definition
The IM is Form CMS-10065, provided to Medicare beneficiaries admitted as hospital inpatients, including people with Original Medicare and Medicare Advantage. It tells the patient how to ask an independent BFCC-QIO to review a discharge that may be too soon.
When the hospital provides it
Medicare.gov states that the notice should be delivered within two days of inpatient admission and before discharge. If it was given more than two days before the planned discharge, the hospital must provide a follow-up copy or a new notice before discharge.
What the notice contains
- Rights to medically necessary hospital care and participation in discharge planning.
- The planned discharge and the right to appeal.
- Contact information for the BFCC-QIO serving the state.
- The deadline and instructions for requesting expedited review.
- Information about when the beneficiary may become responsible for charges.
How it differs from related notices
The Detailed Notice of Discharge, Form CMS-10066, is supplied after a discharge appeal is requested and explains the specific reason the hospital or plan believes inpatient services should end. A Notice of Medicare Non-Coverage is generally used when covered services are ending in settings such as a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice. A Medicare Summary Notice reports claims and is not a hospital discharge notice.
Practical example
A hospital tells an inpatient that discharge is planned for tomorrow. The patient believes essential treatment and home-care arrangements are incomplete. The patient uses the BFCC-QIO contact and deadline on the IM to request a fast independent review before leaving.
Administrative context
CMS formerly identified the IM as CMS-R-193. Its current form number is CMS-10065, and the current Detailed Notice of Discharge is CMS-10066. Hospitals should use the current versions posted by CMS rather than copies saved from an earlier admission.