An Important Message From Medicare
Your Rights While You Are a Medicare Hospital PatientYou have the right to receive all the hospital care that is necessary for the proper diagnosis and treatment of your illness or injury. According to Federal law, your discharge date must be determined solely by your medical needs, not by "DRG's" or Medicare payments.
You have the right to be fully informed about decisions affecting your Medicare coverage, payment for your hospital stay, and for any post-hospital services.
You have the right to request a review by a Peer Review Organization (PRO) of any written Notice of Non-Coverage you receive from the hospital stating that Medicare will no longer pay for your hospital care. PRO's are groups of doctors who are paid by the Federal Government to review medical necessity, appropriateness, and quality of hospital treatment furnished to Medicare patients. The phone number and address of the PRO for your area is:
COLORADO FOUNDATION FOR MEDICAL CARE (CFMC)
720 North Main Street, #315 (World Savings Building)
Pueblo, CO 81003
Talk To Your Doctor About Your Stay in the HospitalYou and your doctor know more about your condition and your health needs than anyone else. Decisions about your medical treatment should be made between you and your doctor. If you have questions about your medical treatment, your need for continued hospital care, your discharge, or your need for possible post-hospital care, don't hesitate to ask your doctor. The hospital's patient representative or social worker will also help your with your questions and concerns about hospital services.
If You Think You Are Being Asked to Leave the Hospital Too SoonAsk a hospital representative for a written notice of explanation immediately, if you have not already received one. This notice is called a "Notice of Non-Coverage." You must have this Notice of Non-Coverage if you wish to exercise your right to request a review by the PRO.
The notice of Non-Coverage will state either that your doctor or the PRO agrees with the hospital's decision that Medicare will no longer pay for your hospital care.
If the hospital and your doctor agree, the PRO does not review your case before a Notice of Non-Coverage is issued. But the PRO will respond to your request for a review of your Notice of Non-Coverage and seek your opinion. You cannot be made to pay for your hospital care until the PRO makes its decision, if you request the review by noon of the first work day after you receive the Notice of Non-Coverage.
If the hospital and your doctor disagree, the hospital may request the PRO to review your case. If it does make such a request, the hospital is required to send you a notice to that effect. In this situation, the PRO must agree with the hospital or the hospital cannot issue a Notice of Non-Coverage. You may request the PRO reconsider your case after you receive a Notice of Non-Coverage, but since the PRO has already reviewed your case once, you may have to pay for at least one day of hospital care before the PRO completes this reconsideration.
IF YOU DO NOT REQUEST A REVIEW, THE HOSPITAL MAY BILL YOU FOR ALL THE COSTS OF YOUR STAY, BEGINNING WITH THE THIRD DAY AFTER YOU RECEIVE THE NOTICE OF NON-COVERAGE. THE HOSPITAL, HOWEVER, CANNOT CHARGE YOU FOR CARE UNLESS IT PROVIDES YOU WITH A NOTICE OF NON-COVERAGE.
Message To Medicare BeneficiariesThe Omnibus Reconciliation Act (COBRA), Sections 9353 c and e, require a review of all written complaints from Medicare beneficiaries about the quality of care they have received. These complaints about the quality of care can be in regards to hospitals, skilled nursing facilities, hospital outpatient departments, ambulatory surgery centers, or home health agencies. This review is to be carried out by PRO's.
If you have a complaint about the quality of care you have received as a Medicare beneficiary, record your complaint in writing and send to:
Colorado Foundation for Medical Care
Attention: Special Review Programs
PO Box 17300
Denver, CO 80217
If you have any questions regarding payment of your bill, charges on your bill, or questions about whether services are paid by Medicare, they should be directed to:
Mt. San Rafael Hospital