Hospital Discharge Appeals

When you are in the hospital, you and your doctor will decide the appropriate time for you to leave. Following your hospital stay, you may need home health care, a skilled nursing facility, or a nursing home. However, the hospital may review your medical record while you are there to decide if you are ready to be discharged. Hospital doctors and nurses do this review to help plan patient discharges more efficiently. To appeal your discharge, call 1-800-725-8339. You can appeal your discharge seven days a week, including holidays. Calls received after business hours will be returned the next day.

What if the hospital plans to discharge me, but I don’t think I’m ready to leave?

• Talk to your doctor. If you are concerned about leaving the hospital, tell your doctor. Your doctor may explain why you no longer require care in the hospital and may discuss other kinds of care with you, such as a skilled nursing facility or home health care. Your doctor may be able to give the hospital more information that could change their decision. 
• If you have been issued an Important Message from Medicare and you think you’re not ready to leave the hospital, you can call TMF Health Quality Institute at 1-800-725-8339 and appeal the discharge decision immediately.
• If you want an immediate review of the hospital’s decision, you must call TMF at 1-800-725-8339 by midnight on the day of discharge before you leave the hospital. TMF will review the hospital’s decision and ask you, your doctor, and the hospital for comments. When the review is finished, TMF will notify you, your doctor, and the hospital of TMF’s decision by telephone.
• If TMF agrees that you should leave the hospital, the hospital may begin billing you at noon on the day after TMF’s decision. This does not mean that you must leave the hospital. Only you and your doctor can make that decision. However, if you choose to stay, Medicare will not pay for the remainder of your hospital bill.
• If TMF does not agree that you should leave the hospital, you may stay in the hospital as long as it is medically needed. Medicare will pay for your stay and you will not have to pay for more than your deductible, coinsurance, and non-covered items.
• If you do not appeal, but decide to stay in the hospital past your planned discharge date, you may have to pay for any services you receive after that date.
• Note: If you miss the deadline for this appeal, you may still request a review of Medicare’s decision to no longer pay for your care at any point during your hospital stay or after you have left the hospital. The Important Message From Medicare will tell you how to request this review.

For more information on Medicare, please call the Medicare Beneficiary Helpline at 1-800 MEDICARE (633-4227).