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.

Mediation

Mediation is a new option to resolve a quality of care complaint under Medicare. This is at no direct cost to you. It is a dialogue between you and your doctor or hospital, facilitated by an impartial third person (the mediator). It is an opportunity for you and your doctor or hospital to tell your story, respond to each other, and resolve your concerns about the way you were treated.

For more information about mediation, call Judy Mask, RN, Manager, Medical Review Services at 678-527-3421, 1-800-982-0411 ext. 3421, GMCF Healthcare Quality Improvement Program, 678-527-3426 or 1-800-MEDICARE.

Consumer Questions and Answers (PDF)
Providers Fact Sheet (PDF)
Provider Frequently Asked Questions (PDF)

Medicare Web site
Questions about Medicare?
Call 1-800-MEDICARE (1-800-633-4227)