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Hospital Discharge Procedures for Medicare Recipients

July 1st 2007 began a new notice procedure for Medicare patients being discharged from a hospital.

Medicare hospitalization coverage provides benefits for 90 days in the hospital for each illness a person is hospitalized for. There is even a 60-day reserve available per each recipient's lifetime.

Hospitals have been known to try discharging a patient before they are ready to go. Hospitals sometimes tell you that you will begin to pay for care because medicare will not after the hospital decides that you are ready to go home or to rehabilitative care.

Sometimes appealing the hospital's decision can provide you with extra days in the hospital while the appeal is being decided upon.

On July 1, 2007, a new hospital procedure was enacted for Medicare patients being discharged from the hospital. The requirement is that they must provide the patient with advance notice of the discharge. The notices also give Medicare patients information about their discharge and appeal rights.

Under previous rules, hospitals gave patients a written Hospital-Issued Notice of Non-Coverage prior to being discharged. Hospitals may still give these notices, but the new rules require hospitals to give two notices to patients of their rights—one right after admission and one before discharge.

Within two days of being admitted to a hospital, they must give you a patient another written notice - "An Important Message from Medicare about Your Rights" that explains your discharge and appeal rights. A patient must read and sign the notice.

A second notice is provided two days before a patient's discharge, although if the hospital stay was three days or less, they only need to give you one notice.

Once you receive a discharge decision and you are not ready to leave, a patient can contact a local Medicare Quality Improvement Organization. They are a group of doctors and other professionals who monitor the quality of care delivered to Medicare recipients. They are paid by the federal government and not affiliated with a hospital or HMO. Lumetra is California's Quality Improvement Organization and their local phone number can be found on the discharge notice(s).

It is very important to contact the Quality Improvement Organization right away and by by noon on the first business day after you receive the discharge notice. Doing this will relieve a patient of having to pay for care while the discharge is being reviewed.

Failing to contact the Organization by noon, the hospital can begin charging you on the third day after you receive the discharge notice. Once a patient requests a review, the hospital is required to give a "Detailed Notice of Discharge." The notice should be given no later than noon the day after you request a review. The detailed notice explains the medical reason behind the discharge.

The reviewer will review the discharge, the medical necessity, appropriateness, and the quality of hospital treatment furnished to you. The hospital cannot discharge you while the review is in process and you will not have to pay for the additional days in the hospital. If you don't agree with the decision, you can ask it to reconsider. The reviewer must issue a decision within three days.

After the reconsideration, if the reviewer still agrees with the hospital's decision, you can appeal to an administrative law judge. You will need legal counsel to help you through this process. You can appeal the ALJ's decision to the Department of Health and Human Services, Departmental Appeals Board. Finally, if you don't agree with the appeals board decision, you can appeal to federal court as long as at least $1,000 is at stake.

If you have any questions, you may contact us or the Health Insurance Counselinig & Advocacy Program at the Council On Aging (714) 479-0107 for more assistance.