Your Medicare rights
The Centers for Medicare & Medicaid Services (CMS) appointed Acumentra Health to protect Medicare beneficiaries’ rights to quality health care in Oregon. Acumentra Health protects your Medicare rights at no cost to you or your family. You or your authorized legal representative can exercise the following rights:
Right to complain about the quality of your medical care
Right to appeal your discharge from a hospital (inpatient) or other facility
Medicare Questions
Call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare website.
Visit the Medicare website for more information about your Medicare review and appeal rights. The Centers for Medicare & Medicaid Services (CMS) runs the Medicare program.
Medicare rights
To read about your rights, you may download Medicare's Your Medicare Rights and Protections publication from the Medicare website, using free software called Adobe Reader. (Download Adobe Reader.) To get a printed copy, call 1-800-MEDICARE (1-800-633-4227). To help protect your rights, Acumentra Health
- reviews complaints about quality of care and works with healthcare providers to correct confirmed problems
- reviews appeals of discharge notices from hospitals and other providers
- advises you about your rights and how to work with your healthcare providers to get the care that is best for you
- works with providers on statewide projects that improve the care received by Medicare beneficiaries
If you or a family member have questions, complaints, or concerns about the quality of care you received in Oregon, please call 1-800-MEDICARE (1-800-633-4227).
Medicare Beneficiary Complaints
You have the right to complain about the quality of your medical care.
If you feel you have not received adequate or appropriate health care, call 1-800-MEDICARE (1-800-633-4227) to speak with a Medicare customer service representative. The representative may refer you to an Acumentra Health staff person who will help you decide how to handle your concern. All complaints are confidential. Acumentra Health will review the care you receive in
- hospitals
- specialty hospitals (such as a psychiatric hospital)
- hospital outpatient areas
- managed care organizations
- ambulatory surgery centers
- skilled nursing facilities
- home health agencies
- hospices
- outpatient rehabilitation facilities
Acumentra Health works directly with the facility or your healthcare provider to correct any problems we find. Acumentra Health staff also evaluates complaints to determine if they are suitable for mediation.
You have the right to receive all the care you need from a hospital (inpatient) or other facility to diagnose and treat your condition.
When you are admitted to a hospital, or to a skilled nursing facility or home health or hospice services, the hospital or facility, or your managed care organization, must give you a printed document called An Important Message from Medicare. This Message explains your rights as a Medicare patient. One of the most important rights is your right to receive medical or skilled nursing services as long as they are 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.)
You have the right to appeal your discharge from a hospital (inpatient) or other facility.
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 this decision by contacting Acumentra Health.
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 you to take:
- Ask a representative of the hospital, facility, or health plan to give you a form called a Detailed Notice of Discharge. You must have this notice if you or your family want to appeal the decision to discharge you.
- 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. If you don't 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
If you are receiving home health services, Acumentra Health cannot review termination of services unless a physician certifies that failure to continue provision of 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.
Contact
For more information use our contact form.