Many people do not know their patient rights if they feel that they are being discharged from the hospital too soon. If you think that it is medically necessary for you to stay in the hospital a little longer or if the transition to post-hospital services is not acceptable to you, you can appeal the decision for your discharge.
Medicare beneficiaries are able to utilize this appeal process since Medicare wants to ensure that each patient is receiving timely, quality health care. Medicare hires a Quality Improvement Organization (QIO) in each state to address health care quality concerns for their beneficiaries. The Center for Medicare and Medicaid requires hospitals to notify patients of their rights to appeal a decision for discharge. This written notification, which is called Important Message from Medicare, must be given to all patients to review and sign within the first 2 days of hospital admission. If you are in the hospital for more than 3 days, you will receive the notice again no less than 4 hours prior to your official discharge.
The timing that you file your request for appeal is crucial for the discharge process and has financial implications that affect you. If you have received official notice of your discharge date and you think it is premature, you must request your expedited review by noon of the next day. You must make your appeal no later than midnight on the date you are to be discharged while you are still in the hospital. This applies if you are admitted in the hospital as an in-patient not if you are in the hospital under observation.
How do you appeal? The process to start the appeal is easy. All of the information is provided in the Important Message from Medicare notice that you reviewed and signed, or someone with your permission did on your behalf. The contact information for the QIO in your state is listed on the notice as well as instructions on how to file your complaint. The QIO that serves Colorado is the Colorado Foundation of Medical Care. Their direct phone number for the Medicare Beneficiaries Hotline for Complaints and for Expedited Review Requests is 800-727-7086.
How does this affect you financially? You can stay in the hospital while Medicare pays for your care until your appeal decision has been determined. Medicare beneficiaries are not financially liable for hospital costs while their case is being reviewed by the QIO (except co-pays and deductibles). If the QIO agrees with you that it is too soon for you to be discharged, then you can stay in the hospital and Medicare will cover your costs. If the QIO agrees with the hospital’s decision for your discharge, then you will be required to pay all hospital bills beginning at noon on the day AFTER notification of the decision was made. Patients do have the right to request an expedited reconsideration if they do not agree with the QIO’s decision. Initiating the appeal process buys you some time and can save you money while the QIO reviews your case. Typically a decision will be made within a few days. If you decide to not appeal the hospital’s decision for your discharge and you continue to stay in the hospital, you will be required to pay all hospital bills after the official discharge date.