Appeal for a Review of Termination of Hospital Services
When you are admitted to a hospital, you have the right to get hospital care that
is necessary to diagnose and treat your illness or injury. The day you leave the
hospital (your discharge date) is based on when your hospital stay is no longer
medically necessary.
If you feel that you are being discharged too soon, call the Ohio KePRO Beneficiary Helpline at 1-800-589-7337 immediately
– before you leave the hospital – and ask for a fast-track review. You should have
a sheet called
“An Important Message From Medicare About Your Rights” in hand when you
call. Patients are given this sheet upon admission and then again before they leave
the hospital.
Once you have submitted your request for a fast-track review, Ohio KePRO will ask
the hospital to write a Detailed Notice of Discharge. The hospital will give Ohio
KePRO and you a copy of the notice. Ohio KePRO will take one day to review your
case.
- If Ohio KePRO agrees with the hospital’s decision You will be responsible
for paying the hospital charges beginning noon of the day after Ohio KePRO gives
you its decision. You are not responsible for payment during the review process
if you request the review in a timely manner.
- If Ohio KePRO agrees with you Medicare will continue to cover services
as long as they are medically necessary.
Appeal for a Review of Termination of Other Healthcare Services
If medical services outside of the hospital are being discontinued, you will receive
a notice at least two days or visits before payment is scheduled to end. This is
called a “Notice of Medicare Provider Non-Coverage.” If you feel that you are being
discharged too soon, call the Ohio
KePRO Beneficiary Helpline at 1-800-589-7337 immediately – before your
coverage ends – and ask for a fast-track review. Please have your “Notice of Medicare
Provider Non-Coverage” in hand when you call.
Once you have submitted your request for a fast-track review, Ohio KePRO will ask
the provider to write a Detailed Notice of Discharge. The provider will give Ohio
KePRO and you a copy of the notice. Ohio KePRO will review your case within 24-72
hours.
- If Ohio KePRO agrees with the provider’s decision You will be responsible
for paying the provider charges beginning noon of the day after Ohio KePRO gives
you its decision. You are not responsible for payment during the review process
if you request the review in a timely manner.
- If Ohio KePRO agrees with you Medicare will continue to cover services
as long as they are medically necessary.