Vol. 14, Issue 14 – July 14, 2015

Can I appeal a hospital discharge?

Dear Marci,

My father has Medicare and is in the hospital after a fall. His doctor and nurses say that he is ready to be discharged from the hospital, but he feels that he is not yet well enough to return home. He has some lingering health issues and wants to stay in the hospital for a few more days. Can he appeal a hospital discharge?

– Fred (St. Louis, MO)

Dear Fred,

Yes, people with Medicare can appeal a hospital discharge if they are not ready to leave. The appeal process for a hospital discharge is different from other Medicare appeals, because hospital discharge appeals follow a fast timeline.

To appeal, your father should first consult the Important Message from Medicare notice, which the hospital should provide a patient at least once during their inpatient hospital stay. Among other things, the notice tells patients how to request a review of their case by the Beneficiary and Family-Centered Care Quality Improvement Organization, often called the Quality Improvement Organization (QIO). The QIO is an independent body that reviews hospital discharge appeals for Medicare beneficiaries.

Know that while the QIO is reviewing your father’s appeal, the hospital must also provide your father with a more detailed notice that explains why it thinks he is ready to leave. This is called a Detailed Notice of Discharge. In the meantime, the QIO will review your father’s medical records and contact him for his opinion on the discharge.

The QIO should make its decision and call your father within 24 hours of receiving all the information it needs. If the appeal to the QIO is successful, your father’s care will continue to be covered.

If your father’s appeal to the QIO is unsuccessful, he will not be held responsible for the cost of the 24-hour period while he waited for the QIO to make a decision. If he remains in the hospital after that period, he may be responsible for the cost of his care if he does not win at a higher level of appeal.

Your father can choose to move to higher levels of appeal. To read about the higher levels of Medicare appeals for hospital care that is ending, click here. Be sure to remind your father to follow rules and deadlines for any higher levels of appeal.

Keep in mind that there are also options for continuing your father’s care after he is discharged from the hospital. He may benefit from home health services while at home, or from care at a skilled nursing facility (SNF).


Health Tip
The U.S. Centers for Disease Control and Prevention (CDC) is reviewing the flu vaccine to ensure that it protects against more strains of the flu virus. Health officials have stated that the vaccines for the 2014-2015 flu season were not effective against a wider variety of flu virus strains. The CDC hopes that through early review of the vaccine, the vaccine for the 2015-2016 flu season will be stronger and protect against more types of the virus.

To read more about the review of the flu vaccine, click here. To read more about the flu from the CDC, click here.

Need to Know
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Dear Marci is a biweekly e-newsletter designed to keep you — 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.

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