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Planning for your discharge from a hospital is one of the most important steps in returning to daily living. The doctor develops your discharge plan to provide continuous care for your needs after leaving the hospital. There are other members of the hospital or HMO staff available to help with discharge planning, including social workers, discharge planners and case managers.
What happens when you, or your caregiver, feel that you have been discharged to soon?
Sometimes you will be told that payment for your hospital or other health care services is ending. This is because your provider decided that this type of care is no longer medically needed. If you feel that payment for your services is ending too soon, you have a right to appeal this decision to Primaris. Primaris reviews your care and decides if Medicare should continue to pay for your services.
When admitted to the hospital and then again before you leave, you should receive a notice called “An Important Message from Medicare.” This notice explains what to do if you feel you are being discharged too soon.
If medical services outside of the hospital are being discontinued, you receive a notice at least two days before payment is scheduled to end. This is called a “Notice of Medicare Provider Non-Coverage.” Read it carefully. It will explain when payment ends and how to appeal if you feel your services should continue.
If you wish to appeal, call Primaris toll-free at (866) 902-1813.
Primaris will contact the hospital or HMO and the physician for additional information along with your medical record. If we agree with you, Medicare coverage will continue as long as inpatient care is necessary. If we agree with the doctor and provider, you may become financially liable for service past a certain date.
One in five Medicare patients is readmitted to the hospital within 30 days after discharge.
To avoid return visits, it’s important for patients and families to play an active role during the discharge planning.
Make sure that these four important steps (see a related video) are completed before leaving the care of a hospital, nursing home, or other healthcare facility:
- Medicine checklist: For each medicine you are taking, make sure that you have information about what the medicine is for, how to take it correctly, and what side effects to watch out for.
- “Red Flag” list: Nearly every illness comes with some signs—“red flags”—that will tell you that you may be having problems or that you need to check with your doctor. Before leaving the hospital or nursing home, know what to watch out for.
- Follow-up appointments: An important part of taking care of yourself after you leave a hospital or other care facility is to be sure to call your primary care doctor to make an appointment right away. When it’s time for discharge, have an action plan to make that appointment. In addition, ask your care team if you need to schedule any lab work or other tests.
- Personal Health Record: A personal health record is a powerful tool that allows patients to organize, store, and keep track of health information. Be sure yours is up to date so that you can share detailed information about your hospital or care facility visit with your primary care doctor and any caregivers who may be helping you at home.