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Disputing Early Discharges from the Hospital

A stay in the hospital for a loved one is often a cause for concern – and even more so if your relative is to be discharged when he or she still seems ill or weak. Medicare beneficiaries can be reassured that they have the right to dispute a perceived early dis-charge from a hospital or acute care setting. A Medicare beneficiary, whether through direct Medicare or an HMO, is guaranteed the right to file an immediate appeal if the family feels the patient is not yet ready to return home or be moved to a lower level of care. This is done through an organization called the California Medical Review, Inc. at the Medicare Helpline, (800) 841-1602.

When a family informs the discharge planner that “I am going to file an appeal of discharge with the California Medical Review, Inc. (CMRI),” the discharge process stops and the family is not responsible for the cost of the additional time in the hospital while the case is reviewed. The appeal must be filed by noon of the day following the notification of discharge or the right to appeal is waived. If the discharge notification comes on a Friday afternoon or after hours, call CMRI and leave a message. The message will record the date and time of the call ensuring your right to appeal. CMRI hours are 9:00 a.m. to 4:00 p.m., Monday through Friday.

The California Medical Review, Inc. is a Medicare mandated nonprofit agency set up to ensure quality of care. Outside of California, contact the Peer Review Organizations (PRO) which can be found in the Medicare booklet Medicare and You 2001 which all Medicare beneficiaries receive.

After an appeal is filed, CMRI will request the medical records and have the case reviewed by an independent physician. The hospital and Medicare beneficiary will then be informed of the decision. The review process can take anywhere from a few hours after receiving the medical records, to two days. CMRI can also investigate claims about insufficient or inadequate care by a physician if, for example, a medication is prescribed which causes a severe reaction. In these cases the person filing the complaint may not be informed of the result of the investigation, but can help to prevent another person from experiencing a similar incident. The person filing the complaint may not subpoena for litigation any of the information gathered by CMRI.

Summer 2001