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.
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.
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:
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.
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 (PDF document), or call 1-800-785-0411 to request this form.
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:
Last updated July 24, 2012