healthcare[hacker]Medicare patients who believe they are being discharged from the hospital too soon can use the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) to request an expedited review **FROM THE PHYSICIAN, NOT THE CASE MANAGER** that temporarily maintains coverage while the decision is made. The discharge process will be paused for this process to play out.
To utilize this right, patients and their families must follow a strict sequence:
1. Obtain the Important Message from Medicare (IM) or Hospital-Issued Notice of Non-Coverage (HINN) from the hospital.
2. Request an appeal from the BFCC-QIO by calling the number listed on the hospital’s discharge notice no later than midnight on the day of the scheduled discharge. If you miss the deadline, you'll likely be on the hook for whatever horse shit number the hospital charges you.
3. Once the appeal is filed, the hospital must provide a Detailed Notice of Discharge (DND) by noon the day after the hospital is notified. This document explains the medical and coverage reasons for the discharge.
4. A doctor not affiliated with the hospital will review your medical records to determine if the discharge is medically necessary. The BFCC-QIO must issue a decision within one day of receiving the necessary information.
5. If the BFCC-QIO agrees with the hospital, you have until noon of the following day to request a reconsideration. The BFCC-QIO has 72 hours (or up to 14 days with an extension) to issue this final determination.
For assistance beyond the appeal, such as clarifying discharge plans without initiating a formal appeal, patients can request Immediate Advocacy Discharge Assistance (IADA) from the BFCC-QIO, though this service can't help you with discharge dates or involve itself in clinical reviews.
More info here: https://www.cms.gov/medicare/quality/quality-improvement-organizations/family-centered-care
Like with all things in our society, if you don't know your rights, you don't have any.
Beneficiary and Family Centered Care (BFCC)-QIOs | CMS
Beneficiary and Family Centered Care (BFCC)-QIOsBeneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIO) help Medicare beneficiaries with their concerns about the quality of care they receive from a Medicare provider. The Quality Improvement Organization (QIO) is a group of health quality experts, providers, and consumers organized to improve the quality of care delivered to people with Medicare.
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