Monica was admitted to the hospital with pneumonia. After five days, she was considered out of danger and her friends and family drew a sign of relief. That is until the hospital’s social worker informed them that Monica was to be discharged within the next 24 hours. She could either return to her apartment with home health assistance or be admitted to a nursing home rehabilitation facility. If she decides on rehab, her friends and family could suggest up to five rehab facilities where the hospital could apply. This information must be supplied in the next few hours.
This policy might sound shockingly fast for a discharge but it is not unusual. In fact this is the standard protocol for hospitals. Hospitals are under intense pressure to discharge patients as quickly as possible after they are out of immediate danger. This is due to Medicare’s payment policy. Medicare pay hospitals a predetermined fixed amount that is tied to each patient’s diagnosis. This practice is called “the prospective payment system”. The hospital is paid the same amount no matter how long the patient stays in the hospital, which encourages the facility to discharge patients as quickly as possible.
Why to Appeal a Hospital Discharge
Too often friends and families are thrown into a quandary on how to proceed. Is the patient really well enough to leave the hospital? Can an apartment be made safe fast enough to accommodate and treat him? How can a family determine the best rehab facility in only a few hours? These are formidable decisions to make in a very short period of time. Fortunately, Medicare offers a safe recourse—any hospitalized patient covered by Medicare can appeal a hospital discharge. An even greater benefit is the patient can stay in the hospital during the appeal process and continue to be treated at no extra cost.
Who Reviews a Hospital Discharge
Every state has at least one Medicare Quality Improvement Organization, (QIO), that will intervene when a person appeals a hospital discharge. A QIO is a private, usually not-for-profit organization that is staffed by health care professionals who are trained to review medical care and determine if a case has merit. The QIO is paid by the federal government and not affiliated with a hospital or HMO. While the QIO is reviewing the appeal, the patient can remain in the hospital—at no cost— until a decision is made. The good news is, even If the QIO decides that patient can be discharged safely, the patient will not be responsible for paying the hospital charges (except for applicable coinsurance or deductibles).
When a patient is first admitted to the hospital he is given a written notice titled “An Important Message from Medicare about Your Rights”. The document explains the steps to take to appeal a discharge decision and lists the QIO’s contact information. But be aware that a person must work quickly to get the appeal started. The family must contact the QIO by noon on the first business day after receiving the discharge notice. So be ready.
How to Appeal a Hospital Discharge
To implement the appeals process, the family must first inform the discharge planner that they feel the patient is being discharged prematurely and ask to file an appeal. The discharge planner cannot legally release the patient from the hospital until the process is reviewed and a decision handed down
The family must work quickly; appeals are handled promptly. An appeal can be reviewed within a one- to two-day time period. So use the time wisely. If you need to research nursing home rehab centers, start making calls and touring facilities. If the patient will be returning home, use this time to prepare the apartment properly. This can mean hiring home health assistance, rearranging the furniture for any necessary medical equipment, and shopping for enough food and medical supplies for at least a week.
Many families are not aware of this important appeal process. Even though every patient is provided with this information in the hospital, few families are aware of its power. By knowing your rights, you can take charge of these emergency situations. You can make sure all a patient’s needs are in place for a really safe hospital discharge. And it is on your own terms.
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