Your Rights as a Medicare Beneficiary
The right to file an appeal if you believe you are being discharged too soon from a Medicare facility
Discharge planning is an important step in returning a patient to the activities of daily living. The doctor develops your discharge plan to provide continuous care for your needs after leaving a skilled facility or hospital. Other members of the staff are also available to help with discharge planning, including social workers, discharge planners and case managers.
What happens when you, or your representative, feel that you have been discharged to soon?
Sometimes you will be told that payment for hospital or other healthcare services is ending. This is because your provider decided that this type of care is no longer medically necessary. If you feel that payment for your services is ending too soon, you have a right to appeal this decision to The Kansas Foundation for Medical Care, Inc. (KFMC). KFMC reviews your care and decides if services are medically necessary and if they are covered by Medicare Coverage Guidelines. A decision will be made to determine whether or not Medicare should continue to pay for your services.
When admitted to the hospital and then again before you leave, you should receive a notice called "An Important Message from Medicare." This notice explains what to do if you feel you are being discharged too soon.
If skilled medical services are being discontinued, you will receive a notice at least two days before payment is scheduled to end. This is called a "Notice of Medicare Provider Non-Coverage." Read it carefully. It will explain when payment ends and how to appeal if you feel your services should continue.
If you wish to appeal, call the Kansas Foundation for Medical Care (KFMC) toll-free at (800) 432-0407, Option 1.
KFMC will contact the hospital or skilled facility, or Medicare Advantage Plan, and also your physician, for additional information. If KFMC agrees with your appeal, Medicare coverage will continue as long as inpatient (hospital) or skilled care (Home Health, Hospice, Skilled Nursing) is medically necessary. If we agree with the doctor and provider that skilled or inpatient services are no longer medically necessary, you may become financially liable for services past a certain date.