How to File a Hospital or Nursing Home Discharge Appeal With Medicare

If you believe that a Medicare patient is being inappropriately discharged from a hospital or nursing home facility, you must file the following procedure from the Department of Health and Human Services to appeal the decision:

Steps to Appeal Your Discharge:

Step 1:  You must contact the Quality Improvement Organization (QIO) no later than your planned discharge date and before you leave the hospital.  If you do this, you will not have to pay for the services you receive during the appeal (except for charges like co-pays and deductibles).

  • Here is the contact information for the QIO: (800) 624-4557 or tty 1-(877) 486-2048
  • You can file a request for an appeal any day of the week.  Once you speak to someone or leave a message, your appeal has begun.
  • Ask the hospital if you need help contacting the QIO.

Step 2: You will receive a detailed notice from the hospital or your Medicare Advantage or other Medicare managed care plan (if you belong to one) that explains the reasons they think  you are ready to be discharged.

Step 3: The QIO will ask for your opinion.  You or your representative need to be available to speak with the QIO if requested.  You or your representative may give the QIO a written statement, but you are not required to do so.

Step 4: The QIO will review your medical records and other important information about your case.

Step 5: The QIO will notify you of its decision within 1 day after it receives all necessary information.

  • if the QIO finds that you are not ready to be discharged, Medicare will continue to cover your hospital services
  • If the QIO finds that you are ready to be discharged, Medicare will continue to cover your services until noon of the day after the QIO notifies you of it’s decision.

IF YOU MISS THE DEADLINE TO APPEAL, YOU HAVE OTHER APPEAL RIGHTS:

  • You can still ask the QIO or your plan (if you belong to one) for a review of your case:
    o If you have Original Medicare: Call the QIO listed above
    o If you belong to a Medicare Advantage Plan or other Medicare managed care plan: Call your plan.
  • If you plan to stay in the hospital, the hospital may charge you for any services you receive after your planned discharge date.

For additional information, call 1-800-Medicare (663-4227) or TTY: 1-877-486-2048

Related Information:

Contact a nursing home abuse attorney

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