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Your discharge plan should include information about where you will be discharged to, the types of care you need, and who will provide that care. It should be written in simple language and include a complete list of your medications with dosages and usage information. To help ensure that your discharge is successful, keep the following in mind:
There are separate processes for hospital and non-hospital appeals. The two sections below review the steps you should follow if you want to appeal your proposed discharge. You can file an appeal to extend your care as long as you feel that continued care is medically necessary. (See Medicare Advantage ending appeals chart for more details.)
A discharge plan must involve information and instructions to you and your caregivers, including a list of medications, referrals for other care (for example, skilled nursing facilities or home health agencies), and details about Medicare coverage of post-hospitalization services. The plan should be developed with input from you and your ...
You can also send additional information about why you, and your care team, if appliable, believe the discharge is too soon. The QIO should call you within 24 hours with their decision. If the QIO agrees with the hospital that Medicare coverage of your hospital stay should end, you have the right to continue to appeal to higher levels of review.
If you have a Medicare Advantage Plan and need care unrelated to your terminal condition, you can choose to either see providers in your plan’s network or see Original Medicare providers. When seeing Medicare Advantage providers, you should follow your plan’s coverage rules, including seeing in-network providers.
For example, you must be considered homebound and have a plan of care approved by your doctor. It is also important to know that your home health care is covered by Medicare even if your condition is chronic or if you are not showing signs of improvement. Speak with your doctor or hospital discharge planner to begin home health care.
You should also be able to find local HHAs through your hospital discharge planning office, 1-800-MEDICARE, or the Eldercare Locator. In either situation, the HHA should evaluate your home health needs and create a plan of care .
Medicare covers up to 100 days of care in a skilled nursing facility (SNF) each benefit period.If you need more than 100 days of SNF care in a benefit period, you will need to pay out of pocket.
You must appeal by midnight of the day of your discharge. The QIO should call you with its decision within 24 hours of receiving all the information it needs. If you are appealing to the QIO, the hospital must send you a Detailed Notice of Discharge. This notice explains in writing why your hospital care is ending and lists any Medicare ...
Be aware that the process is slightly different depending on whether you have Original Medicare or a Medicare Advantage Plan. Also note that there is a separate process if you are appealing because your care is ending .