CMS-HINN 12 Instructions

Hospitals provide Hospital-Issued Notices of Noncoverage (HINNs) to beneficiaries prior to admission, at admission, or at any point during an inpatient stay 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
• Is custodial in nature.

Click on the link "Hospital Discharge Appeal Notices" for notices used to inform beneficiaries of their right to request QIO review of discharge decisions on or after July 2, 2007 or access them via the links below.

Please note:

• HINN 11, which is used for noncovered items or services provided during an otherwise covered stay, and its instructions have not yet been incorporated into Chapter 30 of the Online Claims Processing Manual.
• HINN 12 should be used in association with the Hospital Discharge Appeal Notices to inform beneficiaries of their potential liability for a noncovered continued stay.
• The Preadmission/Admission HINN, used prior to an entirely noncovered stay, replaces HINNs 1 and 9.

Click here for the appropriate page from the CMS website

Additional Resources

Preadmission HINN Example from CMS (This is a .pdf document)

HINN 10 and Instructions (This is a Word2003 Document.)

HINN 12 Sample from CMS (This is a Word2003 Document.)

Detailed Notice of Discharge - Revised 05/07 (This is a Word2003 Document.)