Appealing a Discharge
A patient cannot be discharged from the hospital until he or she is:
- Medically stable
- No longer in need of in-patient services
- Presented with a discharge plan that is safe and adequate
The hospital is required to give the patient a written notice called a "Notice of Discharge" when acute care is no longer required. The form will explain the reason in-patient care is no longer needed. After a patient is informed of his or her discharge date, he or she has the right to appeal the discharge if he or she and/or the physician feel that a longer hospital stay is medically necessary.
Medicare Appeal Process
Any notice you receive should be in writing. After a decision from the Quality Improvement Organization, you should ask about additional appeal rights if you feel you continue to need acute care.
- Initiate Appeal: Contact the Quality Improvement Organization (QIO) listed on the "Notice of Non-coverage" or "Denial Notice." In Maryland, the QIO is the Delmarva Foundation. Call to initiate your appeal before noon of the next business day after receiving the notice.
- Begin Review: Once the review begins, you cannot be sent home until the Quality Improvement Organization completes a review of your care needs. You will not be billed for these days. If the review determines that you need continued acute hospital care, Medicare will continue to cover your medically necessary care.
- Review Outcomes: If the review determines that you are no longer in need of acute care, you will need to leave the hospital, or you will be financially responsible for your care from noon of the day after you receive the decision.
- Second Review: You can request a reconsideration or second review. You have the right to request a reconsideration in writing for up to one year. If your care is still denied, you will be responsible for payment of hospital care received since the date of the initial decision.
Appeal Process if Not Covered by Medicare
- Request the denial of continued acute care in writing, including the reason in-patient care is no longer needed.
- Contact your health plan or insurance company to learn their appeal process. All health plans have an appeal process.
- Carefully follow the appeal process.
- If you do not agree with the decision of the first appeal, continue to appeal.
Remember, if you lose the appeal you will be responsible for payment for the medical care you received from the date of denial.