If you’re on Medicare and believe your services are ending too soon or receiving discharge orders prematurely, you can ask for a fast appeal to fight the hospital discharge. With a fast appeal, the independent reviewer can determine if your services should continue.
You may file a fast appeal if you disagree with the decision about your release from a hospital, home health agency, skilled nursing facility, hospice, or comprehensive outpatient rehabilitation facility.
Keep reading to learn how to fight your discharge with a fast appeal.
How do you contest a hospital discharge with Medicare?
As soon as you decide to file a fast appeal, you can ask your provider to give you a notice of Medicare non-coverage, telling you how to file a fast appeal. Be sure to read the notice carefully.
You contact your Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for assistance filing your appeal. The fast appeal will only cover the decision to end services, and you only need a separate appeal for items you receive after the decision to end services.
The hospital cannot force you to discharge before the BFCC-QUI reaches a decision. So, you can stay in the hospital while reviewing your appeal; coinsurances and deductibles will apply.
The fast appeal is only one type of Medicare appeal, with different appeals for different things.
Within two days of being admitted to a facility and before you’re discharged, you’ll get a notice called “An Important Message from Medicare about Your Rights.” On the notice, there will be contact information for the BFCC-QIO and details about your rights.
How do I ask for a fast appeal?
You must follow the directions on the “Important Message from Medicare” notice to ask for a fast appeal. You’ll want to request the appeal if you think your Medicare-covered services are ending soon.
For a fast appeal, you must request the appeal no later than the day of discharge. But, if you miss the deadline for your fast appeal, different time frames and rules will apply. Also, you’ll likely be responsible for the full cost of the hospital stay past the original day the hospital clears you for discharge.
What happens during the fast appeal review?
Once the BFCC-QIO receives your request for a fast appeal, they will notify the plan, your facility, and your Medicare. When the plan and hospital has notified by the BFCC-QIO of your fast appeal, the plan or the hospital will provide you with a “Detailed Notice of Discharge.”
The BFCC-QIO will review the medical information that the hospital provides, and they will ask you for your opinion. Then, they will decide if you’re ready for discharge within one day of getting the information.
What happens if the BFCC-QIO decides your discharge is too soon?
If the determination after your appeal is that the hospital is discharging you too soon, Medicare will continue to cover your hospital stay if it’s medically necessary. You’ll be responsible for covering any applicable coinsurance or deductible.
If your insurance never authorized the inpatient admission or the inpatient admission wasn’t for emergency care, you may need to appeal the denial of coverage from your plan, which is separate from the fast appeal.
Other than applicable co-insurance and deductibles, you won’t be responsible for paying hospital charges incurred through noon the day after the BFCC-QIO gives you a decision.
Inpatient hospital care received after that will be your financial responsibility.
Medicare hospital discharge rules
Receiving notice when moving from one healthcare place to another is important. This notice can be spoken or written down. It’s especially crucial if the person getting care thinks that leaving is not right. When patients, their families, and their healthcare providers plan well for leaving one place and going to another, it helps things go smoothly.
Notice means getting told about your rights and protections, especially how much things will cost and what services you can get in the new place.
So, it’s important to notice:
- Comes ahead of time, if possible.
- It’s written down or written if it was first said out loud.
- It’s easy to understand.
- It goes to the patient or a family member who can understand and use the information.
The notice should:
- Say when they expect you to leave.
- Tell if it’s from your place, Medicare/Medicaid, or another group.
- Explain how you can disagree with leaving, and give details like where to talk about it, who will check into it, and how long you have.
When you’re getting ready to leave, they should make a plan. This plan should be written and cover:
- Where and how you’ll get care after you leave.
- What you, your family, and your friends can do to help you get better?
- Any health issues that might happen in the new place.
- What medicines do you need to take?
- Getting any equipment or things you need for daily life.
- Places that can help you with your illness.
- Help with costs for your care.
If a Medicare beneficiary requests a fast appeal of their discharge, when is the latest that request can be made?
The latest request for a fast appeal cannot be sent later than noon on the first day after the day before the termination date on your “notice of Medicare non-coverage.”
When a Medicare beneficiary requests a fast appeal, when should they expect a decision?
The BFCC-QIO should decide within 24 hours. A successful appeal means you can remain in the hospital, and your Medicare will continue to cover your care.
What is the “Safe Discharge” policy?
“Safe discharge” laws prevent hospitals from discharging patients who don’t have a safe plan to continue care after leaving the hospital. Also, “Safe discharge” is the term Medicare uses, and if you believe the current plan doesn’t meet the needs of a safe discharge as defined by Medicare, using the terminology may sway the decision in your favor.
How do I file a fast appeal with a Medicare Advantage plan?
For those who have a Medicare Advantage plan, you can ask the plan for an appeal, but different rules apply. Contact your plan for more information.
How Medigap insurance can help lower the cost of inpatient care
Medicare supplement insurance can cover the Part A deductible and coinsurance, saving you lots of money if you’re in the hospital, especially if you’re in the hospital for a long time.
Our licensed insurance agents are Medicare experts who can help you find the best insurance coverage. Their advice and guidance are free of charge.
Give us a call to talk to a licensed agent now. Or, if you prefer, fill out an online rate comparison form to see the top rates in your area.