Effective immediately, the Medical Information Form (MIF) will no longer be available for use. Previously, the MIF was used when a SNF submitted a Demand Bill as requested by the beneficiary. This request was made in order for Medicare to make a determination on the notification of a lower level of care change. As a quality measure and to ensure that all vital information has been captured in the documentation, the MIF will no longer be accepted as supportive medical record documentation. Please discard any supply of the form that you may have within your facility.

Providers will continue to receive an Additional Documentation Request (ADR) when a Demand Bill is submitted. Please do not submit your medical records until receipt of the ADR. The following items may be requested to support the services billed:

1. Notice of Non-Coverage of Services (signed and dated by the beneficiary) requesting Demand Bill Review or the State Medicaid Letter requesting the review.
   
   
2. Applicable UB for the dates of services billed.
   
   
3. We must receive the following additional medical records to substantiate the decision of non-coverage:
   
   
   • Hospital Discharge Summary
   • History and Physical
   • OMRA or MDS
   • Physician Orders, Certification for SNF Care, and Progress Notes
   • Medication Administration Records (MAR)
   • Treatment Administration Records (TAR)
   • Therapy: Initial Evaluations, Treatment Notes, and Discharge Summaries
   • Any additional records deemed appropriate by the facility to substantiate that this should not be a covered stay.

Please respond to the ADR within the designated timeframe in order to ensure timely processing of your claim.

As a general reminder, when medical records are requested from any CMS contractor, if the documentation does not support medical necessity or there is missing or insufficient documentation to support the services rendered, a denial may be issued. Do not forget to include documentation for the look-back period when appropriate.