Discharge Concerns
Discharge planning is one of the most important steps in returning a patient to the activities of daily living. The doctor develops your discharge plan to provide continuous care for your needs after leaving the hospital. There are other members of the hospital or HMO staff available to help with discharge planning, including social workers, discharge planners and case managers.
What happens when you, or your caregiver, feel that you have been discharged to soon?
Sometimes you will be told that payment for your hospital or other health care services is ending. This is because your provider decided that this type of care is no longer medically needed. If you feel that payment for your services is ending too soon, you have a right to appeal this decision to Primaris. Primaris reviews your care and decides if Medicare should continue to pay for your services.
When admitted to the hospital and then again before you leave, you should receive a notice called “An Important Message from Medicare.” This notice explains what to do if you feel you are being discharged too soon.
If medical services outside of the hospital are being discontinued, you receive a notice at least two days before payment is scheduled to end. This is called a “Notice of Medicare Provider Non-Coverage.” Read it carefully. It will explain when payment ends and how to appeal if you feel your services should continue.
If you wish to appeal, call Primaris toll-free at (866) 902-1813.
Primaris will contact the hospital or HMO and the physician for additional information along with your medical record. If we agree with you, Medicare coverage will continue as long as inpatient care is necessary. If we agree with the doctor and provider, you may become financially liable for service past a certain date.
Instructions for discharge appeals are also included in the "Important Message from Medicare" document.