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Hospital Discharge Appeals
Hospital Patient Rights | AZ QIO Contact
| Forms | 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
1600 East Northern Avenue, Suite 100
Phoenix, Arizona 85020-3983
602-264-6382
The quality of medical care they 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.
1600 E. Northern Ave., Suite 100
Phoenix, AZ 85020
602-264-6382
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Forms:
The links below will open new windows.
This interactive version of the forms listed below can be modified to include Hospital Name & Contact Information, as well as specific Patient Identifiers.
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Resources:
Frequently Asked Questions (FAQs)
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 Office: 1-800-447-8477
- State Office for Aging:
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Division of Aging and Adult Services: |
602-542-4446 |
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Fax: |
602-542-6575 |
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State Health Insurance Assistance (SHIP) Hotline: |
1-800-432-4040 |
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Adult Abuse Hotline: |
1-877-SOS-ADULT or
1-877-767-2385 |
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This material was prepared by Health Services Advisory Group, the Medicare Quality
Improvement Organization for Arizona, under contract with the Centers for Medicare
& Medicaid Services (CMS), an agency of the U.S. Department of Health and Human
Services. The contents presented do not necessarily reflect CMS policy. Publication
No. AZ-8SOW-3a-060607-01.
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