General Admission and Registration Rules

10 - General Admission and Registration Rules (Rev. 3441, Issued: 01-15-16, Effective; 12-31-13; ASC X12: 01-01-12, MAC Implementation: 02-16-16; ASC X12: 02-16-16) The following is a general description of requirements and prohibited activities that apply to admission for inpatient services or registration for other healthcare services. Upon admission, Prospective Payment System (PPS) hospitals and acute care hospitals in areas with waivers from PPS are required to give the notice, “An Important Message from Medicare,” to beneficiaries (available at www.cms.gov/Medicare/Medicare- General- Information/BNI/downloads/RevisedImportantMessageFromMedicare05_2007.pdf). The facility inserts its Quality Improvement Organization’s (QIO) name, address, and phone number. It provides this notice to each Medicare patient or the patient’s representative. The CMS does not supply copies of the notice. Upon admission of a Medicare beneficiary to an institution that bills Medicare, or as soon thereafter as practical, the provider must verify a patient’s eligibility in order to process the bill. The provider may obtain this eligibility information directly from the patient or through the provider’s A/B MAC (A)’s limited Medicare eligibility data. See §30.6. The provider contacts its A/B MAC (A) to obtain technical instructions regarding how this access may be implemented along with hardware/software compatibility details. This information does not represent a definitive eligibility status. If the individual is not on file, the provider uses the usual admission and billing procedure in effect, independent of this data access. Disclosure of CMS eligibility data is restricted under the provisions of the Privacy Act of 1974. This information is confidential, and may be used only for verifying a patient’s eligibility to benefits under the Medicare program. Penalties for misuse by anyone may result in being found guilty of a misdemeanor and paying a fine not more than $5,000.