How To Appeal When Someone With Medicare Is Being Discharged

Health care providers are required to give the patient/legal representative a written notice before discharging a patient from an acute care hospital, Skilled Nursing Facility, Comprehensive Outpatient Rehabilitation Facility, Home Health services, or Hospice services. This discharge notice does not mean that all of the patient’s Medicare coverage is ending. Only coverage for the specific services listed on the notice will be ending.

Appealing Discharge From A Hospital

Any Medicare patient, including managed care enrollees, or their designated representative (such as a spouse or caregiver) may request a discharge appeal from the QIO if they believe the patient is not medically ready to leave the hospital.

The hospital is required to provide the patient/legal representative with a copy of “An Important Message from Medicare” no more than two days before discharge and no less than at least four hours before discharge. This notice outlines steps to take to file an appeal. Once you receive the notice, if you believe the patient is not medically ready to leave the hospital, call HealthInsight by midnight of the next business day at 1-800-748-6773. This line is staffed seven days a week including weekends and holidays. If no one is available when you call or you are calling after hours, please leave a message and we will return your call as soon as possible.

An objective physician will look at the medical record to see if the services should continue. There is no charge to the Medicare patient for filing an appeal.

Appealing Discharge From Skilled Nursing Facilities, Comprehensive Outpatient Rehabilitation Facilities, Home Health Services, Or Hospice Services

Any Medicare patient, including managed care enrollees, or their designated representative (such as a spouse or caregiver) may request a discharge appeal from the QIO if they believe the services being discontinued are still medically necessary. The health care provider is required to provide the patient/legal representative with a notice called “Notice of Medicare Provider Non-coverage,” at least two days before the termination of services. This notice outlines steps to take to file an appeal. Once you receive the notice, if you believe the services being discontinued are still medically necessary, call HealthInsight by midnight of the next business day at 1-800-748-6773. This line is staffed seven days a week including weekends and holidays. If no one is available when you call or you are calling after hours, please leave a message and we will return your call as soon as possible.

An objective physician will look at the medical record to see if the services should continue. There is no charge to the Medicare patient for filing an appeal. Call our Medicare Beneficiary Hotline 1-800-748-6773 for more information.