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Early Discharge

Quality Improvement Organizations were created to protect the rights of persons with Medicare in every state and U.S. territory. To help control rising healthcare costs, Medicare began paying acute care hospitals a flat fee, based on a patient’s diagnosis related group, or DRG. This means that Medicare pays the hospital based on your diagnosis – the type of illness or injury you have – and not by the number of days you stay in the hospital.

People frequently ask, “How long should I stay in the hospital for this particular illness?” The answer is always the same. You should stay in the hospital as long as it is medically necessary for you to be there. Therefore, how long you stay in the hospital should be based on your individual medical needs, not your diagnosis. To protect you from being discharged too soon, Medicare has established a free appeal process.

If You Think You Are Being Asked To Leave The Hospital Too Soon

If you are ever told you must leave the hospital before you feel well enough, you have the right to appeal that decision by asking the Medicare QIO in your state to perform a free review of your case. If you are a patient in a Utah or Nevada hospital, HealthInsight is the organization to call. You can think of this review as your right to have a second doctor’s opinion about being medically ready to leave the hospital. You have this right if you have Original Medicare or a Medicare Advantage (formerly Medicare+Choice) plan such as an HMO. If you have not received one, ask a hospital representative for a written notice of explanation immediately. You must have this Hospital Issued Notice of Noncoverage (HINN) if you have Original Medicare, or a Notice of Discharge Medicare Appeal Rights (NODMAR) if you have Medicare Advantage, to exercise your right to request a review by a Medicare QIO.

How Do I Appeal?
In order for the Medicare QIO to perform a review, you must:

It is important to call the Medicare QIO immediately after the notice is issued. You need to request your review by noon of the first business day after you receive the Notice.

If you do this, you will not have to pay for your hospital care until the Medicare QIO makes its decision. If you call during evening hours or on weekends/holidays, leave a detailed message on our answering machine. We will call you back the next business day. Once you have called the Medicare QIO, you can’t be forced to leave the hospital while we are conducting our review. You will not be charged for this review or for the days you stay in the hospital while we are conducting the review. If you do not request a review and the hospital provided you with a Notice of Noncoverage or a Notice of Discharge Medicare Appeal Rights, the hospital can bill you directly for the remaining cost of your stay. The cost to you begins on the third day after you receive the Notice. The hospital, however, cannot charge you for care unless it provides you with the Notice.