May 27

Medicare hospital discharge appeal: How do I file one?

Recently, I had a client's daughter that gave me a call and her father was in the hospital and about to be discharged. The daughter felt like he needed a few more days to fully recuperate. She wanted to know what her options were. Often when you're in the hospital, the nurse comes in and says, "hey, you're being discharged" without any warning. 

How to fight an early hospital discharge

fast appeal stay

You really don't know what your rights are as a member. What you can and can't do if you feel like you're being discharged too soon. A lot of people don't know this, but as a Medicare beneficiary, you have the right to file what's called a fast appeal (read more here). So, if you feel like you're being discharged too soon, you can file a Medicare hospital discharge appeal.  This applies to hospitals, skilled nursing facilities, comprehensive outpatient rehab facilities, home health agencies, and hospice.

Know your rights AND read the fine print about medicare hospital discharge appeals

You should receive a notification at least two days prior to being discharged from that particular facility. This applies whether it is a hospital or skilled nursing facility. Unfortunately, a lot of times we sign whatever is in front of us and we don't read the fine print. Notice that they have put information about a fast appeal (aka expedited appeal or an immediate appeal) in the fine print.

fast appeal contract

Either way, you have the step by step process in asking for an independent party to take a look at that particular case. Know to look for that information if you feel that you or your loved one is being discharged too soon. The name of the independent representation that looks at this is the Beneficiary and Family Centered Care Quality Improvement Organization.

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How do you file a Medicare hospital discharge appeal?

You must ask for a Medicare hospital discharge appeal no later than the day you're scheduled to be discharged. If you appeal within this time frame, you can stay in the hospital while you wait to get the BFCC-QIO's decision. You won't have to pay for your stay (except for applicable coinsurance or deductibles).

medicare hospital discharge appeal check out

If you miss the deadline for a fast appeal, you can still ask the BFCC-QIO to review your case. However, different rules and time frames apply. You might be responsible for the cost of the hospital stay past the original day the hospital tries to discharge you. If you're in a Medicare Advantage Plan, you can ask for an appeal, but different rules apply.

They will generally give you their findings the day after they receive your appeal. They'll tell you whether they feel like it is OK for you to be discharged or whether you get the extra days of stay in that particular facility. Now, keep in mind, if you are granted those extra days, you're not going to be kicked out.  However, the quality person could come back and say, "hey, you should be discharged".

If the BFCC-QIO decides that your services are ending too soon:

Medicare may continue to cover your SNF, HHA, CORF, or hospice services (except for applicable coinsurance or deductibles).

If the BFCC-QIO decides that your services should end:

You won't be responsible for paying for any SNF, HHA, CORF, or hospice services provided before the termination date. If you continue to get services after the coverage end date, you may have to pay.

You'll still be covered for those days, but you will still have to pay your copay/coinsurance that goes with your plan. So just know you will receive that information from that particular facility. Also, you do have that right to file a hospital discharge appeal if you feel like you're being discharged too soon. If you have any questions or concerns, give us a call at Tidewater at 888-622-9122 and we're happy to help.


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