Q&A: Case managers and the Hospital-Issued Notice of Noncoverage (HINN) 12

Q. What role do case managers play in HINN 12 delivery?

A. The HINN 12 is the denial notice most familiar to those who work in case management. This notice, also known as the Continued Stay HINN, is given at the end of a hospital stay when a discharge order is given but the patient chooses to remain in the hospital.

The HINN 12, which requires the patient’s signature to represent his or her understanding, is often the incentive for patients or their families to agree to a plan for discharge. The patient’s legal representative may sign the form if the patient is unable to do so.

Case managers must remember to also give the patient who has the discharge order the follow-up Medicare IM, as noted earlier in this chapter. The case manager would give the patient the HINN 12 if the patient appealed the discharge after receiving the follow-up Medicare IM and the BFCC-QIO agreed with the discharge decision but the patient did not leave the hospital by noon the following day. The form would let the patient know he or she is now liable for the cost of hospital services as of noon on the day following the BFCC-QIO determination.

The patient or his or her legal representative signs the denial notices, and the person signing must have capacity to comprehend the form. The case manager also signs the form as the issuer of the notice. It is best for case managers to deliver notices in person so they can explain the notice and what it means. If the notice cannot be delivered to the patient or his or her representative, the hospital cannot bill the patient for the services. The patient must be given the notice for the transfer of liability for the cost of care to shift to the patient.

Editor’s note: For more information, see the Case Management Patient Communication Toolkit.

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