Filing an expedited appeal with Original Medicare if you are denied admission to the hospital

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Last Update: November 02, 2011

If you are in Original Medicare, you have the right to appeal a hospital's decision not to admit you because it believes Medicare will not cover the stay. See the outline below for details about expedited appeals in Original Medicare.



Hospital denies admission. You receive a Hospital Issued Notice of Non-coverage (HINN).

 





Appeal to Quality Improvement Organization (QIO) within 3 days if you are not admitted, or, if you are, at any time during your hospital stay.

 

The QIO overturns the HINN. Your hospital stay is covered by Original Medicare.
QIO agrees with hospital.
 



Ask the Qualified Independent Contractor (QIC) for a Reconsideration of the QIO's decision.




QIC agrees with hospital. QIC disagrees with hospital, your hospital admission stay is covered by Original Medicare.




Request ALJ Hearing within 60 days. The amount in question must be at least $140 (in 2013).





If you are denied coverage, request Medicare Appeals Council (MAC) Hearing within 60 days.





If you are denied coverage, appeal to Federal District Court within 60 days. The amount in question must be at least $1,400 (in 2013).


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GO TO
Your appeal rights when you are denied admittance to a hospital or are told Medicare wont pay for your hospital stay

What if Medicare denies my appeal?

Medicare coverage of inpatient hospital care

 
LINKS
MyMedicare.gov: Access your Medicare information

Directory of Quality Improvement Organizations by State

The National Committee for Quality Assurance (NCQA)

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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