Transmittal 188 Effective 4/26/19 – Revisions to the State Operations Manual (SOM 100-07) Chapter 2, The Certification Process

Sharon Hamilton MS, RN, CFDS
Clinical Consultant – Briggs Healthcare

2202.9B – Right to See, Review, and Request Changes

(Rev.188, Issued: 04-26-19, Effective: 04-26-19, Implementation: 04-26-19)

The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary’s Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes.

The “Federal Register” notice of June 18, 1999, requires that, under the Privacy Act, Medicare/Medicaid patients have the right to see, review, and request changes in their assessments. HHAs must accommodate patients (or their representative), who request this review. If the patient disputes OASIS information collected as part of a comprehensive assessment, the HHA has two options; it can agree or disagree with the dispute.

1. The HHA Agrees. –If the HHA agrees with the patient’s request, it accepts the request, and changes the applicable OASIS data item(s) on the assessment. A corrected assessment can be submitted to the State, using the terms of the OASIS correction policy.

2. The HHA Disagrees. –If the HHA disagrees with the patient’s request, the patient should request written documentation that the disputed information will not be changed by the HHA including the reason(s) why.

If a patient chooses to pursue his/her request at the Federal level, he/she may contact CMS at 1-800-Medicare, toll free, for further review of the disputed issue. The individual contesting a record will be advised to write to the Privacy Officer, CMS, 7500 Security Boulevard, Baltimore, Maryland, 21244-1850, identify the record, and specify the information being contested. This correspondence must include the HHA’s written documentation refusing the change. It must also state the corrective action sought and the reasons for the correction with supporting justification. (These procedures are in accordance with the Department’s regulations (45 CFR 5b.7.) To preserve the privacy of the OASIS/HHA system of records, the Privacy Act Privacy Officer may require that the individual provide the following information for verification purposes: The system name, Medicare beneficiary identifier, and, for verification purposes, the individual’s name (woman’s maiden name, if applicable), social security number, address, date of birth, and sex. (Furnishing the social security number is voluntary, but it may make searching for a record easier and prevent delay.) This information must be notarized to preserve the confidentiality of this process.

The HHA Medicare/Medicaid patient who wants to know if there is a record belonging to him/her in the OASIS/HHA system of records or wants to review the record contained in the CMS OASIS/HHA system of records repository would follow the same process. The patient can contact CMS toll free at 1-800-Medicare to get instructions for how to pursue his/her request.

This transmittal can be found by clicking on the link below:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019-Transmittals-Items/R188SOMA.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending