Dear Marci,
My father is currently in the hospital, and I think he is being asked to leave before he is ready. Is there anything I can do?
If you feel your father is being asked to leave the hospital (discharged) before he is well enough to go, you can ask for an immediate (expedited), independent review of your case.
It is a good idea to ask a doctor for support. It is best to ask your treating physician, but you could always ask another doctor to lend support.
If you make a formal request for an immediate review within the proper timeframe, the hospital cannot force you to leave before a decision has been made. You should be able to stay in the hospital at no charge while your case is being reviewed. Even if it is decided that you do not need continued hospital care, the hospital cannot charge you for any care received until noon of the next calendar day after you get the review decision.
The first part of the review process is the same whether you are in Original Medicare or a Medicare private health plan.
When you are going to be discharged, you will receive a copy of a notice called an Important Message from Medicare. This is the same document you should have been asked to sign within two days of being admitted to the hospital.
The hospital must provide you with this notice as soon as possible before your discharge, but no more than two calendar days before and not less than four hours before you must leave.
The notice will tell you how to request an immediate review of the hospitals decision to discharge you from the Quality Improvement Organization (QIO). A QIO is an independent group of doctors and other professionals that contracts with Medicare to ensure that you received quality care.
To get an expedited review, you must contact the QIO by midnight on the date you are being discharged (and before you leave the hospital). The QIO will inform the hospital right away.
If you miss the deadline to ask for an immediate review of your case, you can still appeal. However, the hospital can charge you for care you received after your planned discharge date.
The hospital (or your plan if you are enrolled in a Medicare private health plan) must give you a Detailed Notice of Discharge which tells you why services will no longer be covered, a description of the coverage rules and how those rules apply to your case. Expect that no later than noon of the day after it is notified by the QIO that you are appealing the discharge. It is important that you review this notice so that you are prepared when you have your QIO review.
The hospital or your plan must provide the QIO with the information it needs to decide your appeal by noon of the day after it is notified of the appeal. You will be asked to discuss your case with the QIO on the phone. Your doctor can be present for this conversation.
The QIO must contact you and the hospital by phone and then in writing of its decision within one calendar day after it receives all the information. If you disagree with the QIO decision, you can appeal at upper levels. The next levels are slightly different if you are in Original Medicare or a Medicare private health plan.
To find out more about more about your right to appeal, go to Medicare Interactive: (http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=691).
Call the Professional Hotline, a national service offered by the Medicare Rights Center
877-794-3570 from 9 a.m. to 6 p.m. Eastern Time for accurate, up-to-date information
and ongoing technical support.
Dear Marci is a weekly e-newsletter designed to keep people with Medicare, social workers, health care providers and other professionals in the loop about health care benefits, rights and options for older Americans and people with disabilities. Dear Marci is a free service of the Medicare Rights Center (http://www.medicarerights.org).
