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The purpose of the RED process is to support patients from the time they leave the hospital until. the first scheduled primary care provider appointment. The phone call supports a patientâs transition. from the time of discharge until his/her first follow-up primary care appointment. It is important to. include a patientâs support person(s) in the process, if the patient agrees to his/her participation.
Coverage Statement: Hospital services (inpatient and outpatient) are covered when Medicare. criteria are met. All hospital services must be reasonable and necessary to be covered. Decisions on the setting for. delivery of healthcare services should be based on nationally recognized guidelines and evidence-. based medical literature. The CMS Hospital Inpatient Patient Payment Sytem (IPPS) Final Rule provides clarity when.