Hospital-Issued Notice of Non-coverage (HINN) Citations and

7000 - Hospital-Issued Notice of Non-coverage (HINN) Citations and Authority - (Rev. 4, 07-18-03) The statutory authorities applicable to your review of a Hospital-Issued Notice of Non- coverage (HINN) are found at §1154(e), §1154(a), and §1879 of the Social Security Act (the Act). The regulatory authorities for issuing a HINN are found at 42 CFR 489.34, 42 CFR 411.404, and 42 CFR 412.42(c). Hospitals (including ones with swing beds) have the authority to issue notices of non- coverage to beneficiaries or their representatives if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered because it is not medically necessary, not delivered in the most appropriate setting, or custodial in nature. A HINN may be given prior to admission, at admission, or at any point during the inpatient stay (HINNs are discussed in detail in the Hospital Manual, §§414.3-414.10, and model hospital HINNs are contained in §414.11). NOTE: The hospital is not required to issue a HINN when it does not plan to bill the beneficiary or his/her representative. Section 1154(e) of the Act requires you to review all hospital continued-stay notices of non-coverage upon a request by a Medicare beneficiary, his/her representative, or a hospital. This statutory provision does not apply to Quality Improvement Organization (QIO) review involving Skilled Nursing Facility (SNF) swing bed services.