Script for Discharge Anticipation

Presentation:Medicare wants you to understand that you have the right to participate in your discharge planning. Also, even if you have participated in the plan, if you believe that you are being discharged too soon, Medicare has an appeal process you can use. This is a notice that Medicare requires we provide to you in planning your discharge from the hospital — you need to acknowledge that you understand these rights by signing the form at Admission, and again within 48 hours of discharge. You may have already started planning for your discharge with hospital staff or your doctor. If you feel that you are being discharged too early, you can contact our Case Management office to discuss it, or contact Qualis Health to appeal. These are the two phone numbers on your "Important Message" letter.

Why are you giving me this notice? Medicare requires that we provide this notice to all patients who have Medicare Part A or Medicare HMO as their primary or secondary insurance to make sure that you understand your rights as a hospital inpatient.

What is Qualis Health or a Quality Improvement Organization (QIO)?This is an outside review organization that Medicare has hired to help make sure that you receive quality health care. They can look at your case to make an independent decision on whether you are ready to be discharged.

If I don't think I'm ready to be discharged, what should I do?You can discuss this with your doctor or call the Case Management office to discuss the specific reasons. To appeal the decision, you call Qualis Health at 1-877-290-4346. If you get voice mail, you need to leave a message with your name and phone number and tell them that you are at Stevens Hospital. They will want to talk to you to ask you why you don't think you are ready to leave the hospital.

When do I have to call Qualis Health to appeal my discharge date?You may call them as soon as you know your discharge date. You must call them no later than the day of your planned discharge and before you go home.

How soon will Qualis make their decision?Qualis Health will ask the hospital to send copies of your medical record to them to review. Once they receive the information from the hospital, Qualis will make a decision within 1 day.

If I appeal, will I owe extra money to the hospital?During your appeal, you will not have to pay for services you receive except for normal charges like copays and deductibles. If Qualis Health agrees with the hospital that you are ready to be discharged, the hospital will charge you for your care beginning at noon of the day after Qualis makes their decision. If Qualis finds that you are not ready to be discharged, Medicare will continue to cover your hospital stay.

What will happen if I don't appeal, but decide to stay in the hospital?You may have to pay for services you receive after your planned discharge date.

Who do I contact if I have questions about this notice? Call the Case Management department at 425-640-4668. This department has nurse case managers and social workers to help with your care in the hospital. Leave a message with your contact information and someone will return your call during the business hours of 8 a.m. to 4:30 p.m., 7 days a week.

What if I miss the deadline to appeal? You can still ask for a review of your case. If you have Original Medicare, call Qualis Health at the number listed on the form. If you belong to a Medicare Advantage Plan (managed care), call your Plan. If you do not appeal before the deadline, the hospital may charge you for any services you receive after your planned discharge date. If Qualis (or the Medicare Managed Care plan) decides in your favor, the hospital will refund any payments you've made other than your copays and deductibles.