Does Livanta handle admission reviews?
Yes. Livanta must conduct review of admissions and discharges as specified in 42 CFR 476.71(a)(6). Review of the medical record must indicate that inpatient hospital care was medically necessary, reasonable, and appropriate for the diagnosis and condition of the patient at any time during the stay. The patient must demonstrate signs and/or symptoms severe enough to warrant the need for medical care and must receive services of such intensity that they can be furnished safely and effectively only on an inpatient basis.
Download helpful information and resources on Hospital Issued Notices of Non-Coverage
When is the Preadmission/Admission HINN issued?
The Preadmission/Admission HINN is used if the hospital determines the care the beneficiary was about to receive, or was receiving, was not covered, because it was not medically necessary, or was not delivered in the most appropriate setting, or was custodial in nature. The hospital is not required to issue a HINN when it does not plan to bill the beneficiary or his/her representative.
How can I get more information on the status of a QIO HINN review?
You may utilize Livanta’s online case status tool, Arrow by entering the case number. If you need additional information on specific case outcomes, call 1 877 - 588 - 1123
What is the approved HINN format?
While there is no standardized format for the HINN, they must conform to the content outlined in the Medicare Claims Processing Manual. For a sample with appropriate verbiage, you can refer to http://www.cms.gov/Medicare/Medicare-General-Information/BNI/HINNs.html.
Where can I find more information on HINNs?
Please refer to http://www.cms.gov/Medicare/Medicare-General-Information/BNI/HINNs.html
for more information on HINNs.
Is the provider required to issue a Preadmission HINN to patients disputing his or her discharge from outpatient observation?
No, while the provider may have deemed continued outpatient care is no longer necessary, the Preadmission HINN is for proposed inpatient services only.