Early Hospital Discharge How long you stay in the hospital is based upon medical need. To protect you from being discharged too soon, Medicare has established a free appeal process. Medicare updated this appeal process in July 2007 to allow for appeals seven days a week.
Medicare Beneficiary Rights You can file an appeal if you think you are being discharged too soon. You can appeal whether you are a member of a Medicare Advantage plan or a member of Original Medicare.
Medicare Beneficiary Responsibilities If you think you are being discharged too soon, you must call us as soon as you receive the hospital’s Important Message. We will call you to get the facts. If you call us before midnight of the day you are supposed to leave, you can’t be forced to leave the hospital. You can stay in the hospital while we review your case.
You are not required to pay for the time spent in the hospital while we reviewed your case. You are not required to pay until we make our decision. Your duty to pay would begin at noon the day after we make our decision. Here’s how that works. If we decide your hospital stay is medically necessary, Medicare will pay. But if we decide your stay is not medically necessary, and if you want to stay in the hospital anyway, you will be responsible for payment. But the costs do not begin until the day after we make our decision. You don’t have to begin paying until noon the day after our decision.
You can also appeal if the following health care providers want to discontinue care:
- skilled nursing facility, also known as a nursing home
- a home health agency,
- a comprehensive outpatient rehabilitation facility, also known as a rehabilitation center
- hospice
If you are a member of a Medicare Advantage plan, you can’t appeal hospice care.
Medicare Beneficiary Rights
You have the right to appeal as soon as one of these health care providers gives you a written notice that care will be discontinued due to lack of medical necessity. Learn how you can file an early hospital discharge appeal.
Medicare Responsibilities As soon as you get the notice, you must ask for a free review by calling Quality Insights toll-free at 1-866-475-9669. We will contact you and the health care provider to get the information we need to make a decision.