“In addition to telling you your rights as a Medicare patient, the IM gives you the contact information for the organization that will conduct an immediate review of your case, if you feel the hospital is trying to make you leave too soon.”
Medicare patients are not always as profitable for hospitals as patients with other types of health insurance. Hospitals might try to discharge Medicare patients as soon as possible, sometimes before they should. If your loved one is facing this situation, you must know tactics for avoiding early discharge for Medicare beneficiaries.
As a Medicare patient, you have many rights, including the right to receive all medically necessary hospital services. When you check into a hospital as a Medicare patient, the hospital must give you a written notification entitled, “An Important Message from Medicare about Your Rights,” also called the IM. You must receive this within two days of checking into the hospital. If the hospital tries to discharge you before you have been there for two days, they must give you the document before they can discharge you. If they do not, demand one.
Your Rights as a Medicare Patient
You paid for your Medicare coverage through years of deductions from your paychecks. As a Medicare patient, you have the right:
- To receive all hospital services medically necessary
- To be involved in all decisions about your hospital care
- To know who will pay for your hospital services
- To get all medical services you need after discharge
- To appeal the hospital’s decision to discharge you
Besides telling you your rights as a Medicare patient, the IM gives you the local contact information for the organization that will conduct an immediate review (called a fast appeal) of your case, if you feel the hospital is trying to make you leave too soon. This organization is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). The U.S. Department of Health and Human Services (HHS) created BFCC-QIOs to improve the quality of health care for Medicare beneficiaries and to make sure they get the medical and hospital services they need.
Follow the instructions on the IM to request a fast appeal of the hospital’s decision to discharge you, if you believe they should not discharge you yet. The IM explains the steps, including important deadlines you should not miss. If you file your appeal within the deadline, you can remain in the hospital until the BFCC-QIO rules on your appeal.
The Fast Appeal Process
The BFCC-QIO will notify the hospital and your Medicare plan of your appeal. By noon of the day after the hospital gets their notice from the BFCC-QIO, the hospital must give you a “Detailed Notice of Discharge,” explaining why they think you either no longer need hospital services or why your services are no longer covered. They will also identify the Medicare policy they rely on in making this decision.
The BFCC-QIO will review your medical information and ask you for your opinion. Within one day of getting the information, the BFCC-QIO will decide about whether it is medically appropriate to discharge you from the hospital.
If the BFCC-QIO decides you need to stay in the hospital longer, Medicare will continue to pay their part of your hospital bill. You are still responsible for your copays and deductibles. If the BFCC-QIO decides it is not medically necessary for you to stay in the hospital, you must leave by noon of the next day to avoid having to pay for additional services out of pocket.
The laws are different in every state, so talk with an elder law attorney in your area.
Centers for Medicare & Medicaid Services. “Getting a fast appeal in a hospital.” (accessed October 23, 2017) https://www.medicare.gov/claims-and-appeals/right-to-fast-appeal/hospital/fast-appeals-in-hospitals.html
Centers for Medicare & Medicaid Services. “Quality Improvement Organizations.” (accessed October 23, 2017) https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/