Hospital and Nursing Home Discharge: You Have a Right to Appeal

When you or a loved is discharged from a hospital or nursing facility, it can be a very stressful process, and can be even more difficult if the patient, and their family or caregiver, are unaware of their options.  Medicare beneficiaries have important rights to receive proper medical care.

When a Medicare patient enters a hospital or nursing facility, there are strong financial incentives to discharge the patient as quickly as possible.  Medicare usually pays hospitals flat rates, based on the type of medical problem being treated. If the hospital spends less money on medical care than Medicare pays, it makes money, but if the hospital spends more than Medicare pays, it loses money.  Therefore, the doctors and care providers in these facilities are urged to quickly discharge Medicare patients.

To protect patients from being discharged too quickly, Medicare gives the patient the right to appeal hospital discharge decisions. When a hospital, doctor, or Medicare health plan informs you of your planned date of discharge, it is important to tell them immediately if you think you are not ready to leave.  If your concerns about early discharge are not resolved through the staff, you should request an appeal. Medicare will continue to cover your stay, as long as you file the appeal before you are discharged.

When filing an appeal:

• It is best to file your appeal on or just before the planned discharge date.
• To file your appeal, call Health Services Advisory Group (HSAG) at 1-800-841-1602.
• Tell HSAG why you object the planned discharge and provide supporting information.
• After you file your appeal, the hospital (or your Medical health plan) must give you a Detailed Notice of Discharge that explains the reasons it thinks you are ready to be discharged.
• The hospital must send a copy of your medical records to HSAG for its review.

HSAG will usually inform you and the hospital of its decision within one day of receiving the necessary information, and is required to do it by telephone and in writing.  If HSAG decides that you are not ready to be discharged, Medicare will continue to cover your hospital stay. However, if HSAG finds that you are ready to be discharged, Medicare will continue to cover your services until noon, of the day after HSAG notifies you of its decision.

SOURCE: www.canhr.org