{"id":9956,"date":"2013-02-22T16:25:59","date_gmt":"2013-02-22T16:25:59","guid":{"rendered":"http:\/\/www.medicareadvocacy.org\/?p=9956"},"modified":"2018-03-29T16:10:30","modified_gmt":"2018-03-29T16:10:30","slug":"self-help-packet-for-hospital-discharge","status":"publish","type":"post","link":"https:\/\/medicareadvocacy.org\/self-help-packet-for-hospital-discharge\/","title":{"rendered":"Self-Help Packet for Hospital Discharge"},"content":{"rendered":"
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  1. Introduction<\/a><\/li>\n
  2. Hospital Discharge Checklist<\/a><\/li>\n
  3. Hospital Coverage Quick Screen<\/a><\/li>\n
  4. Hospital Discharge Rights & Action Steps<\/a><\/li>\n
  5. Glossary of Terms<\/a><\/li>\n
  6. Federal Regulations<\/a><\/li>\n<\/ol>\n
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    <\/a><\/strong>Introduction <\/strong><\/p>\n

    The Center for Medicare Advocacy produced this packet to help you understand Medicare coverage and how to file an appeal if appropriate. <\/p>\n

    Medicare is the national health insurance program to which many people with disabilities and older people are entitled under the Social Security Act.  All too often, Medicare claims are erroneously denied.  It is your right as a Medicare beneficiary to appeal an unfair denial; we urge you to do so. <\/p>\n

    For additional assistance, contact your State Health Insurance Assistance Program (SHIP).  You can find your state program’s information at https:\/\/www.shiptacenter.org\/<\/a>.<\/p>\n

    <\/a>Hospital Discharge Checklist<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
    \uf0f0<\/span><\/td>\nStep One: <\/strong>Review the “Quick Screen for Inpatient Hospital Care<\/a>” included in this packet to determine whether the hospital care you need is covered by Medicare.<\/span><\/td>\n<\/tr>\n
    \uf0f0<\/span><\/td>\nStep Two:<\/strong> Review the document entitled, “Hospital Discharge Rights<\/a>.”<\/span><\/td>\n<\/tr>\n
    \uf0f0<\/span><\/td>\nStep Three:<\/strong> Ask for a copy of your discharge plan. Review the plan.<\/span><\/td>\n<\/tr>\n
    \uf0f0<\/span><\/td>\nStep Four: <\/strong>If you disagree with the plan either because you need to stay in the hospital for more care, or because the hospital is sending you to a skilled nursing facility too far away from your community, or because you need to go to a skilled nursing facility and the hospital is sending you home, ask for a Hospital Issued Notice of Non-Coverage. <\/span><\/td>\n<\/tr>\n
    \uf0f0<\/span><\/td>\nStep Five: <\/strong>Once you receive the Hospital Issued Notice of Non-Coverage, immediately call the BFCC-QIO<\/a>, the entity that reviews Medicare decisions.  Its telephone number will be on the Hospital Issued Notice of Non-Coverage.  Explain to the BFCC-QIO why the decision to end Medicare coverage and your discharge plan is inappropriate. <\/span><\/td>\n<\/tr>\n
    \uf0f0<\/span><\/td>\nStep Six: <\/strong>If the BFCC-QIO agrees with the hospital, ask it to reconsider its decision.  After you receive the initial decision, <\/span>you have until noon of the following day<\/strong> to request the Reconsideration.  <\/span>NOTE<\/strong>:  If you do this, and are not successful, you may become financially responsible for your hospital stay if you remain in the hospital. <\/span><\/td>\n<\/tr>\n
    \uf0f0<\/span><\/td>\nStep Seven: <\/strong>If you are not successful with the Reconsideration, appeal to the Administrative Law Judge<\/a>. <\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    <\/a>Medicare Coverage for inpatient Hospital Care: A Quick Screen to Aid in Identifying Coverable Cases<\/strong><\/p>\n

    Medicare claims for inpatient hospital care are suitable for Medicare coverage, and appeal if they have been denied, if they meet the following test:<\/p>\n

    The patient's condition must have been such that the care he required could only have been provided in a hospital, or<\/strong>, after a 3 day hospital stay, he required a skilled nursing facility (SNF) level of care, and no SNF bed was actually available.  (Note:  A SNF level of care means that the patient required skilled services – from a physical therapist or a registered nurse, for example – on a daily basis.)<\/p>\n

    ADDITIONAL ADVOCACY TIPS:<\/strong><\/p>\n

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    1. The opinion of the patient's attending physician is the most important element in your case.  If the physician believes it is medically necessary for the patient to receive care in the hospital, or that he needs at least a skilled nursing facility level of care but no skilled nursing facility bed is actually available, you probably have a winning case.<\/li>\n
    2. Ask the attending physician to put his or her favorable opinion in writing, explaining with as much detail as possible why<\/u> the coverage standard described above is met in the patient's case.<\/li>\n
    3. Usually a Medicare denial doesn’t mean that the patient must leave the hospital, but rather that any further stay will be at his own expense.<\/li>\n
    4. The patient is entitled to "expedited" review, which may allow additional time in the hospital before charges accrue, if the review is requested immediately.  The Medicare denial notice given by the hospital will tell you how to immediately appeal by calling the Beneficiary and Family Centered Card Quality Improvement Organization (BFCC-QIO).  <\/a>BFCC-QIOs are divided into five service areas:\n