Beneficiary Complaint Review
The
information on this page is intended for health care professionals. If
you are a patient with Medicare and have a concern about the quality of
your medical care, please
click here.
Hospital Initiated Notice of Non-Coverage
Reporting
All Texas hospitals are required to send a copy of the Hospital Initiated
Notice of Non-coverage (HINN) letter to TMF within three days of when the notice is issued. However, a monthly HINN log is no longer required.
Expedited Appeal Review for
Termination of Fee-For Service Medicare Coverage
On July 1, 2005, new Medicare regulations (the Benefits and Improvement
Protection Act §521) gave beneficiaries access to a new expedited
determination process.
Mediation
TMF is now offering mediation as a new option to resolve Medicare
beneficiary complaints about the medical care they receive under the
Medicare program.
For More Information
For more information, contact TMF’s Review & Compliance Department at 1-800-725-9216 or by e-mail at
hpmp@tmf.org. |
Overview of TMF and Medicare Case Review
TMF conducts a number
of mandatory case reviews including, but not limited to, beneficiary
complaint review.
Additional Physician Reviewers Wanted
TMF is seeking additional physicians from across the state to conduct
utilization and quality reviews.
HPMP Resources
Resources for monitoring and preventing Medicare payment errors
can be found on the new Hospital Payment Monitoring Program
(HPMP) site.
Review-Related Frequently Asked Questions
Have a question about
Medicare case review?
Medicare Appeal Rights
As of January 1,
2004, Medicare Advantage enrollees must receive a notice at least two days before
planned termination of Medicare coverage of their skilled nursing
facility (SNF), home health agency (HHA) or comprehensive outpatient
rehabilitation facility (CORF) services.
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