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Hospital denies admission. You receive a Hospital Issued Notice of Non-coverage (HINN).
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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.
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| The QIO overturns the HINN. Your hospital stay is covered by Original Medicare. |
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QIO agrees with hospital. |
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Ask the Qualified Independent Contractor (QIC) for a Reconsideration of the QIO's decision. |
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QIC agrees with hospital. |
QIC disagrees with hospital, your hospital admission stay is covered by Original Medicare. |
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Request ALJ Hearing within 60 days. The amount in question must be at least $140 (in 2013). |
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If you are denied coverage, request Medicare Appeals Council (MAC) Hearing within 60 days. |
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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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