Hospital Discharge Appeals
Hospitals must notify Medicare beneficiaries of their rights as a hospital patient,
including an opportunity to appeal the decision to be formally released or discharged
from inpatient care. “Hospital” is defined as any facility that provides inpatient
care, including short- and long-term acute care; critical access; psychiatric and
rehabilitation. Hospitals must use “An Important Message from Medicare about Your
Rights” to explain these rights.
Final versions of “An Important Message from Medicare About Your Rights” (CMS-R-193)
and “Detailed Notice of Discharge” (CMS 10066) are posted at www.cms.hhs.gov/bni.
Click “Hospital Discharge Appeal Notices.”
Manual instructions are posted in the Medicare Claims Processing Manual (Pub 100-04)
Chapter 30, Section 200 at www.cms.hhs.gov.
In Georgia, the Quality Improvement Organization (QIO) contact information for “An
Important Message from Medicare About Your Rights” is:
Georgia Medical Care Foundation
1-800-982-0411 ext 3413
TTY/TDD 1-877-486-2048
Hospital-Issued Notice of Non-Coverage (HINN)
Hospitals provide Hospital-Issued Notices of Non-coverage (HINNs) to Medicare beneficiaries
prior to admission, at admission, or at any time during an inpatient stay if the
hospital determines that the care is not covered because:
- It is not medically necessary.
- It is not delivered in the most appropriate setting.
- It is custodial in nature.
If you do not agree with the hospital’s decision you should:
- Speak to your physician.
- Ask for a written hospital-issued notice of non-coverage.
- Call for an immediate medical review at 1-800-982-0411 ext 3413.
Beneficiary Quality of Care Complaints
GMCF's Medical Review Services audit patients' medical records on request to ensure
that the highest quality of medical care is being delivered. Either you or your
representative may request a review of the care delivered in most settings. To make
a quality of care complaint: call toll-free 1-800-MEDICARE. Visit the Medicare website
Questions about Medicare?
Call 1-800-MEDICARE (1-800-633-4227)