APPEALS - MPRO

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4 APPEALS – Hospital Discharge The right to appeal If you are told that you will be discharged from the hospital and feel you still need medical care, you have the right to appeal the discharge. Within 48 hours of admission to the hospital, you should receive a form called “An Important Message from Medicare.” This form outlines your right to appeal your hospital discharge if you feel that you are being discharged too soon. Who can request an appeal? Any Medicare patient or his/her designated representative (such as a spouse or caregiver) can request an appeal. How do I file a hospital discharge appeal? To file an appeal, the hospital should provide you with a copy of “An Important Message from Medicare.” The form should be given no more than two days before discharge and no less than at least four hours before discharge. The form outlines the steps to take to appeal a discharge. Once you receive the form, call MPRO no later than midnight of the planned discharge date. How long does the appeal take? Appeals are generally resolved within one or two days. The appeals process is free. In addition, the hospital may not discharge you until the appeal is completed or you decide that you are ready to leave. How am I notified about the outcome of the appeal? MPRO will contact you or your designated representative, the hospital, if applicable the physician and/or health plan. Do I contact MPRO to file a hospital discharge appeal if I’m hospitalized outside of Michigan? No, you would contact the Medicare-designated Quality Improvement Organization in that state. The hospital you
are in will provide you with “An Important Message from Medicare” which includes the contact information for filing an appeal in that state. Appeals – Other Discharges Discharge Appeals from other Health Care Facilities • Skilled Nursing Facilities • Comprehensive Outpatient Rehabilitation Facilities • Home Health Agencies • Hospices Skilled nursing facilities, comprehensive outpatient rehabilitation facilities, home health agencies, and hospices are required to provide you with a notice called “Notice of Medicare Provider Non-Coverage,” for Medicare traditional fee-for-service beneficiaries or a “Notice of Medicare Non-Coverage” to Medicare Advantage beneficiaries, at least two days before you are discharged. You can appeal a decision if you feel you are not ready to be discharged, or if you feel you have a legitimate medical reason to continue receiving medical services. You can also appeal these discharges by contacting MPRO. You must file your appeal with MPRO no later than noon of the day before the effective date listed on your notice. If you contact MPRO after this time, your appeal will take longer, you may be liable for charges, and if you are enrolled in a Medicare Advantage Plan you will only be able to appeal to your health plan. Who can request an appeal? Any Medicare beneficiary or his/her designated representative (such as a spouse or caregiver) can request an appeal. Again, MPRO’s appeal services are free! 5
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APPEALS - MPRO

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