Why Advocates Must Know Patients’ Rights

Patient rights are the foundation of all patient advocacy.  When healthcare providers (such as hospitals, physicians, nursing homes, home care, and medical equipment companies) know that you know what the law requires, you will avoid or at least quickly resolve problems.

Rights come from many sources.  Medicare and Medicaid providers (including the ones listed above) must meet standards called Conditions of Participation (CoPs) or Conditions for Coverage (CoP).  Patient rights are part of those standards.  When providers fail to meet those standards, they might be sanctioned or fined.

Patient rights also come from federal regulations such as the Patient Self-Determination Act (PSDA), Emergency Medical Treatment and Labor Act (EMTALA), Health Insurance Portability and Accountability Act of 1996 (HIPAA); and the Americans with Disabilities Act (ADA).  Patient rights also come from state laws, such as those governing services including mental health, developmental disabilities, older adults and children services.

Advocate Alliance is dedicated to empowering patients and their advocates with information and tools to resolve the most commonly encountered issues. Please know  that this blog is not intended as legal advice or a comprehensive analysis of healthcare law.  You should always seek legal advice specific to your situation.

How to Appeal an Early Hospital Discharge as a Medicare Patient

If you are being discharged early from the hospital, it’s not uncommon to experience feelings of “Wait! I’m not ready!” You may feel medically unprepared to go home, and the thought of being discharged too soon is scary. Fortunately, if you’re in this situation, there is a way to appeal an early hospital discharge. In this article, we will show you how to appeal an early discharge and advocate for a longer hospital stay. The Centers for Medicare and Medicaid Services gives Medicare patients, as well as individuals in a Health Maintenance Organization (HMO), the right to appeal an early discharge.

In order to make sure that patients know their right to an appeal, the hospital must provide them with “An Important Message from Medicare.”

Appealing an Early Discharge: the First Steps

If you are a Medicare patient or individual in an HMO who does not feel ready to leave the hospital on the planned discharge date, you or your representative can appeal the decision. First, talk to your doctor about the discharge, and ask whether or not it can be changed to a later date. Explain why you do not feel that you’re ready to leave the hospital.

If your doctor is unwilling to change the date, or if he or she is unable to do so, you need to contact your state’s Quality Improvement Organization—QIO. Contact the QIO no later than the planned discharge date. Explain to your state’s QIO, verbally or in writing, why you feel that the discharge date is too soon. Note: KEPRO is the QIO in over thirty states. If you are unsure whether or not your state has KEPRO, click here to view the map. KEPRO serves the Midwest and much of the South.

The QIO will review your discharge and take the information you have provided them into consideration. The QIO will review your medical record and decide whether or not you, the Medicare patient, should stay in the hospital. Once they have come to a decision about whether or not you can stay, they will inform you and the hospital of their decision. Once you appeal to the QIO, you are allowed to stay in the hospital while the organization is reviewing the discharge. The cost of your care during this period is covered by Medicare.

What happens when QIO makes the decision?

If QIO determines, after their review of your medical record, that you are not ready to be discharged, you may not be discharged from the hospital. You are allowed to stay. Medicare will continue to cover the cost of services you receive until you are healthy enough to be discharged.

If the QIO determines that the discharge was justified and appropriately-timed, Medicare will continue to cover the services until noon of the day after the QIO has informed you of its decision. After that time, you will be responsible for paying for your own medical care. It will no longer be covered by Medicare or your HMO.

To review: if you are a Medicare patient or individual in an HMO who wants to appeal an early discharge, the first thing you should do is talk to your doctor. If your doctor is unable or unwilling to charge the discharge date, contact your state’s Quality Improvement Organization (QIO) to ask them to review the discharge.

If you feel that you are being discharged too early, you have the right to appeal the decision. Your discharge date is not permanent, and if you feel that you are being forced out of the hospital before you are medically ready, you should take the steps above to try to reverse that decision.