Council on Aging Senior Guide 2013 - 101

soon. The notice also explains how to file an appeal.

COUNCIL ON AGING ORANGE COUNTY

Notifying You of Your Rights To make sure you are informed about your discharge rights in a timely manner, hospitals must usually give you the Important Message from Medicare twice, once upon admission and again before discharge. The hospital must first give you the Important Notice from Medicare at or near admission, but no later than two days after admission. At that time it must ask you to sign and date the notice. The hospital must give you the original copy of the signed notice and keep a copy for its records. Before you are discharged, the hospital must give you another copy of the Important Message from Medicare. It must give you this notice as far in advance of your discharge as possible, but no more than 2 days before your planned date of discharge. The second notice is not required during very short hospital stays if the original notice was given to you within two days of your planned discharge date. If the hospital gives you the second notice on the date of your discharge, it must deliver it to you at least four hours before your planned discharge. The hospital must deliver the Important Message from Medicare to you in person. However, if you cannot understand the notice, the hospital must deliver it to your representative and ask him or her to sign it. Your representative can be someone who has legal authority to act for you, a family member or close friend. Appealing Hospital Discharge Decisions Your hospital, doctor, or Medicare health plan will inform you of your planned date of discharge. If you think you are not ready to leave the hospital, tell your doctor and the hospital staff immediately about your concerns. Ask your doctor to advocate for your interests. Sometimes hospitals and health plans pressure doctors to arrange quick discharges. You should request an appeal if your concerns about early discharge are not resolved. You can stay in the hospital and Medicare will continue to cover your stay as long as you file the appeal before you are discharged. Once you appeal, you will not have to pay for the services you receive during the appeal (except for charges like copays and deductibles). It is best to file your appeal on or just before the planned date of discharge. Ask for an “Immediate Review.” Your representative, such as a legal agent or family member, can
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file an appeal on your behalf. To file your appeal, call Health Services Advisory Group (HSAG) at 1–800–841–1602. HSAG is a “Quality Improvement Organization” (QIO) – a private organization working under contract with Medicare in California to handle certain appeals and other matters. Tell HSAG why you object to the planned discharge and provide any information that supports your appeal. For more information about HSAG or appeals, go to the HSAG web site at http://www. hsag.com/camedicare/index.asp#qio After you file your appeal, the hospital (or your Medicare health plan) must give you a Detailed Notice of Discharge that explains the reasons it thinks you are ready to be discharged. The hospital will send a copy of your medical records to HSAG for its review. These appeals are completed quickly. HSAG will notify you and the hospital of its decision, usually within one day after it receives the necessary information. n If HSAG finds that you are not ready to be discharged, Medicare will continue to cover your hospital stay. n If HSAG finds you are ready to be discharged, Continued on page 102

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Council on Aging Senior Guide 2013

Table of Contents for the Digital Edition of Council on Aging Senior Guide 2013