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Hospital Discharge Appeals

Hospital Patient Rights | AZ QIO Contact | Forms | CMS Resources

Hospital Patient Rights:

Health Services Advisory Group, Inc. (HSAG), Arizona's Quality Improvement Organization (QIO), contracts with the federal government to evaluate and improve care provided to people on Medicare and to ensure their rights. All Medicare Beneficiaries are protected by rights whether they are in the original Medicare plan or another Medicare health plan.

All Medicare Beneficiaries Have The Right To:

  • Protection from discrimination in marketing and enrollment practices.
  • Information about coverage and what their costs might be.
  • Information about all treatment options.
  • Appeal decisions to deny or limit payment.
  • Know how their health plan doctors are paid.
  • Choose a women's health specialist.
  • Receive a treatment that includes direct access to a specialist for serious conditions.
  • Receive emergency care.
In The Hospital All Medicare Beneficiaries Should Also:
  • Receive all the hospital care they need.
  • Receive a written discharge plan.
  • Exercise their right to appeal if they are given a written "Important Message from Medicare" stating that Medicare will no longer cover their care.
  • Speak to a hospital patient representative to help them understand any notices they receive.
Before All Medicare Beneficiaries Go To The Hospital They Should:

  • Plan ahead by speaking to their doctor about their condition and knowing what to expect.
  • Understand their Medicare hospital coverage.
    Call 1-800-MEDICARE to ask questions about their coverage and their rights.
  • Take a family member or a friend in the event that they need additional support understanding their treatment needs and rights.
At The Time Of Admission To The Hospital All Medicare Beneficiaries Will:

  • Receive the "Important Message from Medicare." It describes their rights and how to appeal.
At The Time Of Discharge:

If the beneficiaries are told that Medicare will not pay for continued days of care in the hospital they will receive the second Important Message from Medicare. They should:

  • Speak to their doctor and other caregivers about their discharge plan.
  • If they disagree with the hospital discharge and choose to appeal, call HSAG at 1-800-359-9909 no later than midnight on the scheduled day of discharge. If, for example, a patient is to be discharged on Saturday, the patient must request an appeal no later than midnight on Saturday.
People in Medicare Advantage (MA) plans must use the MA appeals process to appeal admission denials but can use HSAG's process or the MA process for hospital appeals of continued stay denials.

If they lose the appeal, the hospital can bill them from noon of the day after they get HSAG's decision. The next level of appeal is called a "reconsideration." They should always ask about additional appeal rights.

If they received an Important Message from Medicare and missed the deadline for appeals, they can still request a review at any time during their hospital stay or after they are home.

If they are given the follow-up Important Message from Medicare, and choose not to appeal, the hospital will issue a HINN 12 and notify the patient of when the patient will be financially responsible for the continued stay.

If you have additional questions regarding the Medicare hospital appeals process, click here to view Frequently Asked Questions (FAQs).

Expedited Non-Coverage Reviews - Beneficiaries may call HSAG's Case Review Department upon receipt of an "Important Message from Medicare" for a review of their care. All Medicare patients, including managed care enrollees, are entitled to a review of their medical stability as evidenced by the medical record, with protection against premature discharge and an assurance that an adequate, safe patient discharge plan has been formulated and that the patient has been properly informed about their discharge rights. The review also identifies patient liability for payment and describes further appeal rights.

For more information about Medicare Hospital Patient Rights, call the HSAG Helpline at 1-800-359-9909 (Statewide).
Available 24 hours a day, 7 days a week.

Or write to HSAG at:

Health Services Advisory Group
3133 East Camelback Road, Suite 300
Phoenix, Arizona 85016-4501
602-264-6382


The quality of medical care Medicare patients receive is important to us. All Medicare Beneficiaries can call our helpline at the number listed above if they have questions about the quality of services they received in any of the following settings: hospitals, doctors' offices, ambulatory surgery centers, home health agencies, hospice, skilled nursing facilities, hospital emergency rooms and outpatient areas, as well as in managed care organizations.

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AZ QIO Contact:


For additional provider information, please call the HSAG Arizona Medicare Helpline.

HSAG Arizona Medicare Helpline:

1-800-359-9909 (Statewide)

Available 24 hours a day, seven days a week.

Location:

Health Services Advisory Group, Inc.
3133 East Camelback Road, Suite 300
Phoenix, AZ 85016-4501
602-264-6382

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Forms:


The links below will open Zip Files that contain numerous documents.
  • Important Message From Medicare About Your Rights: English and Spanish (Zip File)
    Clicking on this link will open a File Download dialog box. Once opened, click "Open" to view the forms. The following forms are included in the Zip File:
    • English: Important Message from Medicare About Your Rights (instructions included)
    • Spanish: Important Message from Medicare About Your Rights (instructions included)

  • Detailed Notice of Discharge: English and Spanish (Zip File)
    Clicking on this link will open a File Download dialog box. Once opened, click "Open" to view the forms. The following forms are included in the Zip File:
    • English: Detailed Notice of Discharge (instructions included)
    • Spanish: Detailed Notice of Discharge (instructions included)

  • HINN (Hospital Issued Notice of Noncoverage) Links
    Clicking on this link will open a File Download dialog box. Once opened, click “Open” to view the documents. The following documents are included in the Zip File:
    • HINN 12—Noncovered Continued Stay Form and Instructions
    • HINN 11 Form and Instructions (in folder)
    • HINN 10 Form and Instructions (in folder)
    • Preadmission/Admission Form and Instructions
CMS Resources Other Contacts
  • Social Security Administration: 1-800-772-1213 for TTY/TDD 1-800-325-0778
  • Medicare Fraud Hotline: 1-800-633-4227 for TTY/TDD 1-877-486-2048
  • Inspector General's Fraud Helpline Office: 1-800-447-8477
  • State Office for Aging:
    Division of Aging and Adult Services: 602-542-4446
    Fax: 602-542-6575
    State Health Insurance Assistance Program (SHIP) Hotline: 1-800-432-4040
    Adult Abuse Hotline: 1-877-SOS-ADULT or
    1-877-767-2385


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