On Medicare and not ready for hospital discharge?

9 years ago

To the editior:

If you have Medicare, or if you are a family caregiver of someone who relies on Medicare for their primary health insurance, you need to understand some important rights. Staff at the Aroostook Agency on Aging are seeing an increase in complaints from people recently hospitalized and their dissatisfaction, in some cases, could have been prevented had they understood their rights.

If you believe you’re being discharged from a hospital too soon, you have the right to immediate review of the discharge decision by a medical team completely independent of the hospital. Medicare has designated a company called Livanta as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) to do this review.

You may be able to stay in the hospital with Medicare continuing to pay for your care (coinsurance and deductible may apply) while Livanta reviews your case. The hospital can’t force you to leave before Livanta reaches a decision and this process usually takes one to three days.

Prior to your discharge, you should get a notice called “An Important Message from Medicare about Your Rights”. If you don’t get this notice, ask for it. This notice lists Livanta’s toll-free contact Helpline 1-866-815-5440 and explains:

Your right to get all medically necessary hospital services;

Your right to be involved in any decisions that the hospital, your doctor, or anyone else makes about your hospital services and to know who will pay for them;

Your right to get the services you need after you leave the hospital;

Your right to appeal a discharge decision and the steps for appealing the decision;

The circumstances under which you will or won’t have to pay for charges for continuing to stay in the hospital; and

Information on your right to get a detailed notice about why your covered services are ending.

If you don’t feel you are ready to be discharged, perhaps feeling you are too weak to return home, you need to call Livanta and tell them you want to appeal the hospital’s discharge decision. If you are to be discharged that same day, call immediately and tell Livanta you need a fast appeal. You must make the call before the discharge happens.

If you ask for your appeal before the discharge is in effect, you can continue to stay in the hospital without paying for your stay (except for applicable coinsurance or deductibles) while you wait to get the decision from Livanta. This process takes at least a day and sometimes as long as three days.

If you miss the deadline for a fast appeal, you can still ask Livanta to review your case, but different rules and time frames apply.

Medicare has authorized Livanta to directly assist Medicare patients with quality of care concerns regarding their hospital care or care received from skilled nursing facilities, hospice or home health agencies. Examples of some concerns might include a medication mistake, insufficient discharge information, a change in condition not recognized or not treated, contracting an infection or illness while at the medical facility. Complaints may be made by calling Livanta at 1-866-815-5440.

All of this may seem overwhelming for an older person hospitalized and in a weakened state. For this reason it is important they have a spouse or other family member or a friend helping as an “advocate”.

Livanta makes new technology available that may be especially helpful for family caregivers that live “away” yet provide needed help. A free Smartphone app known as “Medicare Quality Helpline” provides at just a tap on the screen quick and easy access to a Livanta nurse who can start an appeal or discuss a quality of care concern. Patients and their caregivers also can use another technology called “Arrow” to track the progress of their early discharge appeals from hospitals and other health care providers.

More information on this technology can be found at www.bfccqioarea1.com.

Steve Farnham, executive director

Aroostook Agency on Aging