The notice you should get
If Medicare covers your hospital stay, the hospital must give you "An Important Message from Medicare about Your Rights" within two days of admission, and again before you're discharged. It explains your right to a fast appeal and gives the QIO's phone number. If you didn't get it, ask the nurse or case manager for it.
The BFCC-QIO (Beneficiary and Family Centered Care Quality Improvement Organization) is an independent group of doctors and reviewers that Medicare pays to handle these appeals. For Oregon, Alaska, Idaho and Washington, it is Acentra Health.
How to appeal
- Read the Important Message. Check the planned discharge date and the QIO's number.
- Call Acentra Health at 1-888-305-6759. TTY users call 1-855-843-4776. Call no later than your planned discharge day, before you leave.
- Tell them you want a fast appeal. Explain why you aren't ready to go home. Your doctor can support you.
- Get the Detailed Notice of Discharge. The hospital must give it to you by noon the day after the QIO contacts it. It explains why the hospital thinks you're ready.
- Wait for the decision. The QIO decides within one day after it gets the information it needs.
What you pay
- If you appeal on time, you can stay in the hospital while you wait, and you don't pay for those days except usual deductibles and coinsurance.
- If the QIO agrees you should stay, Medicare keeps covering your stay.
- If the QIO agrees with the hospital, you aren't responsible for charges until noon the day after the decision. Days after that may be yours to pay.
If you're under observation, not admitted
Being kept overnight doesn't always mean you're an inpatient. If you're an outpatient under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice (MOON). Your status affects what you pay and whether Medicare later covers skilled nursing care, so ask.
For other kinds of denials, see how to appeal a Medicare denial and our appeals guide.
Related questions
How do I appeal a Medicare denial in Oregon?
The five levels and deadlines.
How can I help a parent with Medicare in Oregon?
Permissions, paperwork and planning.
Does Medicare cover skilled nursing in Oregon?
Care after a hospital stay.
Sources
- Medicare.gov — Fast appeals
- Medicare.gov — Inpatient hospital care
- CMS — Beneficiary and Family Centered Care QIOs
- Acentra Health — Medicare quality improvement organization
More questions in this guide
- How can I help my parent with Medicare in Oregon?
- How do I appeal a Medicare denial in Oregon?
- How do I file a complaint about a Medicare insurance agent in Oregon?
- How do I find a licensed insurance agent for Medicare in Oregon?
- How do I find Medicare doctors in Oregon?
- How do I report Medicare fraud in Oregon?
- What are the Medicare phone numbers for Oregon?
- Where is the Social Security office near me in Oregon?
Part of the guide: Medicare Appeals in Oregon · All questions
Frequently asked questions
What if I miss the deadline?
You can still ask the QIO to review your discharge, but different rules and time limits apply, and you may have to pay for days you stay past your planned discharge.
Does this work if I have Medicare Advantage?
Yes. Hospitals give the Important Message to Medicare Advantage members too, and you can ask the QIO for a fast review. Your plan's notice explains the steps.
Can a family member appeal for me?
Yes. A family member or other representative can call the QIO for you. The hospital must give the notice to your representative if you can't act for yourself.
What if I'm being discharged from a nursing facility or home health?
You get a Notice of Medicare Non-Coverage at least two days before services end. Call the QIO by noon the day before your services are set to end.
Medicare in your Oregon county
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