Hospitalization is by definition a traumatic experience for most patients. Fortunately, Medicare covers 90 days of hospitalization per illness in addition to a 60-day lifetime reserve. That said, it is not uncommon for hospitals to try and discharge Medicare patients before they are ready, primarily as a means of saving the hospital money. While the hospital cannot force you to leave or deny you health care services, it can start charging you for those services even though you’re a Medicare patient, so it is important to understand your rights and have a plan of action for navigating this stressful situation.
Hospitals are required to give patients a written notice of discharge as well as appeal rights. One notice will be given to you upon admission and a second notice will be given to you before discharge. Hospitals typically give you a notice called “An Important Message from Medicare about Your Rights” which you are required to read, sign, and date within two days of your admission. If you subsequently receive a discharge notice before you are ready to leave, you need to contact a local Medicare Quality Improvement Organization immediately. The Quality Improvement Organization, or QIO, is a group of doctors and specialists who assess the care given to Medicare patients. The QIO is not affiliated with the hospital, and is instead compensated by the government.
Contact the Quality Improvement Organization (QIO)
As long as you contact your local QIO by noon (12:00 p.m.) on the first business day after receiving your hospital discharge notice, you will be exempt from paying for your care while the discharge order is reviewed. If you fail to contact the QIO in time, the hospital can legally charge you for services. After you request a review of the discharge order by the QIO, the hospital will give you a more detailed notice that includes the medical reasoning for the discharge order. The QIO will then review this medical reasoning as well as the care you have received up to that point. While the reasoning is being reviewed, you will not be charged for hospital services or additional days in the hospital. You can also request that the QIO reconsider its decision if it doesn’t rule in your favor. This reconsideration process can last an additional three days, during which the hospital cannot charge you for its services.
If the QIO rules against you a second time, you may then appeal to an administrative law judge. You should also obtain the services of a lawyer at this point. Keep in mind that the procedure outlined above may vary somewhat based your state of residence. It is the responsibility of you or your family caretaker to read and understand the hospital notices and contact the QIO in a timely manner if you feel you are being discharged too early. You can search for QIOs by state at QualityNet.org.