A Medicare appeal for a hospital discharge order is more common than most might think. Do you think that your Medicare-covered hospital stay is coming to an end, much too soon? If so, you have the right to ask for an appeal.
Below we will discuss what you need to know about appeals. Also, we go over processes for when appealing a hospital’s discharge order.
Understanding the Basics of Medicare Appeals for Hospital Discharge Orders
There are five levels of appeals, all of which we will discuss; however, only the first two levels are necessary when working with a faster appeal. There are different procedures with fast appeals of discharge from a hospital setting versus non-hospital facilities.
Below we will focus primarily on appeals in the inpatient hospital setting.
Inpatient Hospital Appeals
If you find yourself in the hospital, you can expect to receive an Important Message from Medicare within your first two days of your stay. This will thoroughly explain your rights as a patient, as well as request your signature.
If your inpatient stay lasts more than three consecutive days, you should receive yet another copy of the Important Message from Medicare before leaving the hospital.
Level 1 Expedited Medicare Appeal for Hospital Discharge Order
If you find yourself in a position where the hospital advises that you must leave, and you don’t agree with this decision, be sure to follow the instructions on the Important Message from Medicare.
You’ll file this faster appeal with the Quality Improvement Organization (QIO), you must do this by midnight the day of discharge.
A decision happens within 24 hours. If you’re appealing and working with the Quality Improvement Organization, your hospital facility will need to explain why your treatment is coming to an end.
Quality Improvement Organization Decision
The Quality Improvement Organization should request a copy of your medical records from your hospital. You may want to provide a written statement regarding your opinion on discharge, however, the QIO will typically call you for this information.
If you find that your appeal has been unsuccessful, you won’t be responsible for the cost of the 24-hour timeframe. Those in the hospital longer are responsible for the cost of care.
If you end up leaving the hospital or the deadline for filing an expedited appeal is missed, you will have thirty days from the original discharge date to request a review from the QIO. You’ll then receive a written decision.
Level 2 Expedited Medicare Appeal for Hospital Discharge Order
If your appeal to the QIO is successful, you will continue to receive covered care through Medicare. If you find your appeal is denied, you’ll be able to file an appeal with the Qualified Independent Contractor (QIC).
For this, you’ll have until noon of the day following your denial from the QIO to file this appeal. A decision is typically made within 72 hours of the QIC receiving this appeal.
Qualified Independent Contractor Decision
You cannot receive a bill until the QIC makes its decision if you continue to stay in the hospital facility. Please know, however, if you end up losing your appeal, you’ll be responsible for all costs.
This includes any and all costs incurred during the 72 hours of deliberation through the QIC.
If you end up leaving the hospital or the deadline for filing your appeal, you can complete the standard appeal procedure that will give up to 180 days to complete an appeal with the QIC. This decision is made in 60 days.
Level 3 Medicare Appeal for Hospital Discharge Order
If your QIC appeal has approval, your hospital facility will continue your care.
Office of Medicare Hearings and Appeals
If you find a denial, and your care’s cost is at least $160, you may choose to appeal to the Office of Medicare Hearings and Appeals (OMHA) within 60 days of your QIC denial.
This decision happens in 90 days.
Level 4 Appeal
If your OMHA appeal has approval, the cost of your care will have coverage. If you experience denial, you can opt to appeal to the council within 60 days of your OMHA denial.
The council has no deadline when making its decision.
Level 5 Appeal
If the Council approves the appeal, the cost of your care has coverage. If you experience denial, and the cost of care totals at least $1,630, you may choose to appeal to the Federal District Court within 60 days of your Council denial.
Again, the Federal District Court doesn’t have a timeframe in which to decide regarding your appeal.
If you have any questions regarding IRMAA appeals and Medicare, please check out our article here.
Get help understanding Medicare Appeals for Hospital Discharge Orders
Medicare appeals for hospital discharge orders aren’t always easy. When one of our clients needs assistance we are happy to walk them through the necessary steps. One of the many perks of purchasing coverage through our company.
If you have questions give one of our Medicare experts a call at the number above or fill out an online rate form. We do more than just enroll you in coverage, we hold your hand through any Medicare difficulty.