Appealing a discharge notice from a hospital or other provider

Your right to health care

Your Medicare rights include

• the right to receive all the care you need from a hospital (inpatient) or other facility to diagnose and treat your condition
• the right to stay in the hospital, skilled nursing facility, home health care, or hospice setting as long as it is medically necessary (up to a limit per benefit period; to find out if you have exhausted your allowable days per benefit period, contact your Medicare Part A fiscal intermediary).

When you are admitted to a hospital, or to a skilled nursing facility or home health or hospice service, the facility or your managed care organization must give you a printed document called An Important Message from Medicare. This document explains your rights as a Medicare patient, including your discharge appeal rights.

Your right to appeal a discharge notice

Medicare will pay for all reasonable and medically necessary health care from a hospital, skilled nursing facility, home health agency, or hospice.

If the hospital, facility, or Medicare Advantage health plan tells you that you no longer need to receive skilled nursing care or that Medicare will no longer pay for your care, you have the right to appeal the discharge or termination decision by contacting Acumentra Health.

How to appeal a discharge or termination decision

Important: If you want to appeal, you must contact Acumentra Health no later than your planned discharge date and before you leave the hospital or facility.

Steps for appealing a discharge or termination decision:

1. Ask a representative of the hospital, facility, or health plan to give you a form called a Detailed Notice of Discharge, which they are required to give you. You must have this form from the provider if you or your family want to appeal the decision to discharge you.
• Home health cases: get a Certification of Need form (required)
2. Call Acumentra Health at 1-800-785-0411 immediately and request that Acumentra Health review your case.

An Acumentra Health physician reviewer will determine whether you are medically ready to leave the hospital or discontinue the Medicare services. If you do not request a review, you may have to pay for any care you receive after the date given in the Detailed Notice of Discharge.

Home health services—Certification of Need form

Acumentra Health cannot review termination of home health services unless your physician certifies that failure to continue the services may place your health at significant risk.

Download the Physician Certification of Need form, or contact Acumentra Health at 1-800-785-0411.

Review of a Hospital-Issued Notice of Noncoverage (HINN) issued before or at the time of admission

Medicare provides a process for beneficiaries to appeal if they receive a notice from the hospital before or at admission indicating that Medicare will not cover their hospital admission. To begin the appeal process, the beneficiary must contact Acumentra Health, using the special helpline number below.

Helpline for appealing a pre-admission/admission notice of noncoverage:
1-800-344-4354
TTY: 1-800-735-2900
TTY within Oregon: 7-1-1