A Guide to Your Stay at MetroHealth
Ohio KePRO: An Important Message to Medicare Beneficiaries about Your Rights
Your rights while you are a hospital patient
- You have the right to receive all the hospital care that is necessary for the proper diagnosis and treatment of your illness or injury. According to federal law, your discharge date must be determined solely by your medical needs not be any method of payment.
- You have the right to be fully informed about decisions affecting the coverage and payment for your hospital stay and for any post-hospital services.
Talk to your doctor about your stay in the hospital
You and your doctor know more about your condition and your health care needs than anyone else. Decisions about your medical treatment should be made between you and your doctor. If you have any questions about your medical treatment, your need for continued hospital care, your discharge, or your need for possible post-hospital care, don’t hesitate to ask your doctor. Your health plan, the hospital’s patient representative or social worker will also help you with your questions and concerns about hospital services.
If you think you are being asked to leave the hospital too soon
Upon admission you will receive a written copy of an Important Message from Medicare about your rights. If you have not already received it, you may request it from Case Management. This document explains your Medicare discharge rights regarding a review by a quality review organization. Peer Review Organizations (PROs) are groups of doctors who are paid by the federal government to review medical necessity, appropriateness, and quality of hospital treatment furnished to Medicare patients.
You may exercise your right to request an immediate review by the Peer Review Organization (PRO) if you disagree with the discharge plan and/or discharge date. Those enrolled in a managed care plan (like an HMO), have the same right to review.
How to request an immediate review of the decision for discharge
If you disagree with your health plan's discharge decision:
- You must contact the Quality Improvement Organization (QIO) no later than your planned discharge date and before you leave the hospital. If you do this, you will not have to pay for the services you receive during the appeal (except for charges like co-pays and deductibles).
- You can file a request for an appeal any day of the week. Once you speak to someone or leave a message, your appeal has begun.
- Ask the hospital if you need help contacting the QIO.
- Contact information for the QIO:
Rock Run Center, Suite 100
5700 Lombardo Center Drive
Seven Hills, OH 44131
- You will receive a detailed notice of discharge from the hospital or your Medicare Advantage or other Medicare managed care plan (if you belong to one) that explains the reasons they think you are ready to be discharged.
- The QIO will ask for your opinion. You or your representative need to be available to speak with the QIO, if requested. You or your representative may give the QIO a written statement, but you are not required to do so.
- The QIO will review your medical records and other important information about your case.
- The QIO will notify you of its decision within one day after it receives all necessary information.
- If the QIO finds that you are not ready to be discharged, Medicare will continue to cover your hospital services.
- If the QIO finds that you are ready to be discharged, Medicare will continue to cover your services until noon of the day after the QIO notifies you of its decision.
- If you do not request a review from the PRO, the health plan or hospital may bill you for all the costs of your stay beginning at the point when the health plan's hospital coverage ends as noted in the Important Message from Medicare.
The health plan or hospital cannot charge you for care unless you received the Important Message information.
If you miss the deadline to appeal, you have other appeal rights:
- You can still ask the QIO or your plan (if you belong to one) for a review of your case:
- If you have Original Medicare: Call the QIO listed above.
- If you belong to a Medicare Advantage Plan or other Medicare managed care plan: Call your plan.
- If you stay in the hospital, the hospital may charge you for any services you receive after your planned discharge date.
For more information, call 800-MEDICARE (800-633-4227) or TTY: 877-486-2048.