Hospital early discharge appeal chart (Original Medicare)

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Last Update: July 27, 2012

You have the right to appeal the hospital's decision to discharge you before you leave the hospital and the appeal will be expedited. See the outline below for details for how to appeal if you have Original Medicare.

 


Hospital ready to discharge

 






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.

 






Appeal to QIO by midnight on the date of discharge while you are still in the hospital.

 





QIO agrees with hospital

 



QIO disagrees with hospital
You can stay in hospital

 






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.

 







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.

 



QIC disagrees with hospital You can stay and Medicare pays.

 






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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Your appeal rights if you feel you are being asked to leave the hospital too soon

Medicare coverage of inpatient hospital care

Timeline for Medicare appeals

How much will Medicare pay if I am in the hospital?

 
LINKS
Medicare Publication - Your Rights and Protections (PDF)

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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