Hospital ready to discharge
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You receive follow-up Important Message from Medicare notice no more than two calendar days and no later than four hours prior to discharge. Follow-up notice not required for hospital stays of three days or less.
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Appeal to QIO by midnight on the date of discharge while you are still in the hospital.
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QIO agrees with hospital
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QIO disagrees with hospital You can stay in hospital
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You can either leave by noon the next day or stay and ask the Qualified Independent Contractor (QIC) for a reconsideration. If you stay, you may have to pay all costs starting from noon following the day you receive the oral or written QIO decision.
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QIC agrees with hospital. You can either leave (and you will have to pay all hospital costs starting from noon following the day you receive the oral or written QIO decision) or stay and agree to pay for all costs yourself. If you stay, you can appeal the denial of coverage later.
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QIC disagrees with hospital You can stay and Medicare pays.
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Request ALJ Hearing within 60 days of receiving denial of coverage from Medicare. The amount in question must be at least $140 (in 2013).
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