Beneficiary Discharge Appeals

When Medicare beneficiaries are discharged from hospitals, skilled nursing facilities, home health agencies, hospice, or comprehensive outpatient rehabilitation facilities they are entitled by Federal Statute to appeal their discharge. As the Medicare quality improvement organization (QIO) for Arizona and California, HSAG is the designated agent to review all beneficiary discharge appeals—also known as expedited reviews or fast track appeals—to determine if covered services should be continued and if the patient should be allowed to stay in his or her health care setting. These appeals are performed by HSAG 24 hours a day, seven days a week and are based on medical record review, with a decision being rendered by an HSAG physician advisor (licensed to practice in the state where the patient’s health care is provided) in all cases.