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What are Hospital Issued Notice of Non-Coverage (HINN) Letters?


Like the Hospital Advance Beneficiary Notice (HABN), Hospital-Issued Notices of Noncoverage (HINNs) are notices given by a hospital to let the patient know that Medicare may not cover their admission or inpatient stay while at the hospital.  The notice is usually given to the patient in the form of a letter.  When a hospital believes that Medicare will not pay for a patient’s admission or continued stay at their hospital, they are required to notify the patient in writing .  This allows the patient to be fully informed about decisions they must make that are affected by their Medicare coverage as well as payment for his or her inpatient stay at the hospital.

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 services the patient 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.

Hospitals should determine in what instances HINNs are appropriate (i.e., patient admission does not meet inpatient criteria and the patient will be expected to pay for the inpatient stay).  The business office and case management department can provide examples.  Once examples are compiled, education should be provided to business office and case management employees, as well as physicians and/or Hospitalists as appropriate.

More information on HINN letters can be found at: https://www.cms.gov/BNI/05_HINNs.asp

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