Ohio Department of Aging
Site MapSite HelpContact Us Text Size:
October 2007
Medicare Beneficiaries Can Fight Hospital Discharge
What can a person do if he or she is admitted to a hospital as a Medicare patient and the hospital tries to discharge him or her before he or she is ready? Medicare covers 90 days of hospitalization per illness, plus a 60-day "lifetime reserve." While the hospital can't force the individual to leave, it can begin charging him for services.
Within two days of admission to a hospital, the hospital must give patients a notice called "An Important Message from Medicare about Your Rights" explaining discharge and appeal rights. Patients must read the notice, sign it, and date it. Two days before discharge, the hospital must provide another copy. For hospital stays of three days or less, the hospital only needs to give one notice.
If the patient receives a discharge decision and he is not ready to leave, he should immediately contact his local Medicare Quality Improvement Organization (QIO), whose phone number should be on the notice.
The QIO must be contacted by noon on the first business day after receiving the discharge notice so the patient will not have to pay for care while he or she waits for the discharge to be reviewed. If the patient doesn't contact the QIO by noon, the hospital can begin charging the individual on the third day after receiving the discharge notice.
Once a QIO review is requested, the hospital is required to provide a "Detailed Notice of Discharge" which explains the medical reason behind the discharge.
The QIO will review the medical necessity, appropriateness and quality of hospital treatment. The hospital cannot discharge a patient while the QIO is reviewing the discharge decision, and the patient will not have to pay for the additional days in the hospital. If the patient doesn't agree with the QIO's decision, he or she can ask it to reconsider. It must issue a decision within three days.
If the QIO still agrees with the hospital's decision, there are still several appeals steps available. A qualified elder law attorney will likely be necessary to guide the patient through this process.
Ohio Department of Aging