A hospital stay can be stressful for both patients and their families. For many Medicare beneficiaries, the situation becomes even more concerning when a hospital announces a discharge before the patient feels ready to leave.
While hospitals regularly make discharge decisions based on medical and administrative guidelines, Medicare patients have important rights if they believe a discharge is premature. Understanding these rights — and acting quickly — can help protect access to needed care.
As elder law attorneys, we often advise families that you do have the right to appeal a hospital discharge and exercising that right can sometimes extend Medicare-covered care during a critical time.
Medicare Coverage for Hospital Stays
Medicare Part A provides coverage for inpatient hospital care. Generally, Medicare covers:
- Up to 90 days of hospital care per benefit period
- Up to 60 lifetime reserve days if additional hospital care is needed
A benefit period begins when you are admitted to a hospital and ends after you have been out of the hospital or skilled nursing care for 60 consecutive days.
Even though coverage may be available, hospitals may determine that a patient no longer requires inpatient care and attempt to discharge them earlier than the patient or family believes is appropriate.
Hospitals cannot physically force a patient to leave, but they can begin charging for continued care if Medicare coverage ends. This is why knowing how to respond quickly is so important.
Your Rights as a Medicare Patient
Medicare requires hospitals to inform patients about their discharge and appeal rights.
Hospitals must provide two key notices called “An Important Message from Medicare About Your Rights” (IM).
First Notice: Shortly After Admission
Within two days of being admitted, the hospital must provide this notice explaining:
- Your right to receive medically necessary services
- Your right to appeal a discharge decision
Patients must sign and date the notice acknowledging receipt.
Second Notice: Before Discharge
The hospital must provide another copy of the IM within two days before discharge.
If the hospital stay lasts three days or less, the hospital may only provide the notice once.
These documents are important because they contain the contact information needed to file an appeal.
How to Appeal a Hospital Discharge
If you believe you are being discharged too soon, you have the right to request an expedited review of the discharge decision.
Step 1: Contact the Quality Improvement Organization (QIO)
You must contact your local Medicare Quality Improvement Organization (QIO).
A QIO is an independent organization made up of doctors and health care professionals who review the quality and appropriateness of medical care provided to Medicare patients.
The phone number for your QIO is listed on the Important Message from Medicare notice.
Step 2: Act Quickly
Timing is critical.
To request an expedited review, you must contact the QIO by midnight on the day of your scheduled discharge while you are still in the hospital.
If you file the request on time:
- The hospital cannot discharge you while the review is pending
- You will not be financially responsible for covered hospital services during the review
If you miss the deadline, Medicare coverage may end and you could become responsible for the cost of additional hospital care.
What Happens After You File an Appeal
Once the QIO is contacted, the hospital must provide a Detailed Notice of Discharge.
This notice must be delivered by noon the day after the hospital learns about the appeal and must explain:
- Why the hospital believes discharge is appropriate
- The medical reasons supporting the decision
- The Medicare coverage rules involved
The QIO will then review the case. Doctors and medical professionals evaluate:
- Whether continued hospital care is medically necessary
- The appropriateness of the treatment provided
- The quality of care delivered
During this review period, the hospital cannot discharge you.
What If the QIO Agrees with the Hospital?
In many cases, the QIO may uphold the hospital’s discharge decision.
However, filing the appeal still provides an important benefit: it can buy the patient additional days of Medicare-covered hospital care while the review takes place.
If you disagree with the QIO’s decision, you can request reconsideration. The QIO must issue a reconsideration decision within three days.
Beyond that, additional levels of appeal are available, including:
- Review by a Qualified Independent Contractor
- A hearing before an Administrative Law Judge
- Review by the Medicare Appeals Council
- In some cases, federal court review
Because the appeals process can become complex, many families choose to consult legal counsel for assistance.
Observation Status: An Important Medicare Loophole
One of the most confusing issues for Medicare patients involves observation status.
Hospitals sometimes classify patients as being under “observation” rather than formally admitted as inpatients, even if the patient is staying overnight in a hospital bed and receiving treatment.
This distinction is extremely important.
Why Observation Status Matters
If you are under observation:
- You generally do not have the right to the expedited QIO discharge appeal process
- Your hospital stay does not count toward the three-day inpatient requirement for Medicare-covered skilled nursing care
For many patients, this means they may not qualify for Medicare coverage of a subsequent stay in a skilled nursing facility.
Because of this, it is critical to ask hospital staff:
“Am I admitted as an inpatient, or am I under observation status?”
Understanding this distinction can have major financial and medical implications.
Facing a hospital discharge when you or a loved one still needs care can be overwhelming. Fortunately, Medicare provides important protections and appeal rights designed to ensure patients receive appropriate medical treatment.
It is important to act quickly if you believe a discharge decision is premature. Contacting the Quality Improvement Organization before the midnight deadline can preserve your rights and temporarily extend Medicare coverage while the case is reviewed.
It is even more important and advisable to begin communications with the hospital staff before a discharge notice is issued. Towards this end it is often beneficial to utilize the services of a geriatric care manager to serve as a patient advocate and request care conferences to establish a dialogue and plan before any discharge plans are formalized.
If you or a loved one rely on Medicare and encounter difficulties with hospital discharges, the Elder Law attorneys at Mandelbaum Barrett PC can help you understand your rights, navigate the appeals process, and protect access to necessary care.