For Medicare Beneficiaries
The Magee treatment team will assess your functional level within the first three days of your stay so they may complete the Inpatient Rehabilitation Facility Patient Assessment Instrument form. The Assessment is repeated towards the end of your stay to measure your progress. Magee is required to provide the information in the Assessment to Medicare. As a Medicare beneficiary you have the following rights:
- The right to be informed of the purpose of the patient assessment data collection
- The right to have the patient assessment information kept confidential and secure
- The right to be informed that the patient assessment information will not be disclosed to others, except for legitimate purposes allowed by the Federal Privacy Act and Federal and State regulations
- The right to refuse to answer patient assessment questions
- The right to see, review and request changes on the patient assessment instrument.
Your Rights While a Medicare Hospital Patient
You have a right to receive all of the care that is necessary for the proper diagnosis and treatment of your illness or injury. Your discharge date should be determined solely by your medical needs, not by Medicare payments. You have the right to be fully informed about decisions affecting your Medicare coverage or payment for your hospital stay. You have the right to appeal any written notices you receive from your hospital or Medicare stating that Medicare will no longer pay for your care.
Talk To Your Doctor
You and your doctor know more about your condition and your health needs than anyone else does. If you have questions about your medical treatment, your need for continued hospital care or your discharge date, consult your doctor. These decisions should be made between you and your doctor. If you have questions or concerns about hospital services, you should talk to your case manager. Don’t hesitate to ask questions.
Peer Review Organizations
Peer Review Organizations (PROs) are staffs of doctors and nurses who are paid by the federal government to review medical necessity, appropriateness and quality of hospital treatment furnished to Medicare patients. Peer Review Organizations will respond to your request for review and appeal of written Notices stating that Medicare will no longer pay for your hospital stay.
If You Think You Are Being Asked to Leave the Hospital Too Soon
Ask a hospital representative for a written notice of explanation immediately if you have not already received one. The hospital’s written notice is necessary if you decide to appeal to the PRO. The written notice must describe how you appeal.
If you decide to appeal, do so immediately by either calling or writing the PRO. If you lose the appeal, you may be billed for all costs of stay beginning with the third day after you receive the written notice. The appeals process can take up to three working days from the time your appeal request is received. Thus, if you appeal and lose, you may have to pay for at least one day of hospital cost. Remember: Without a written notice, you have no right to appeal.
Notice to Medicare Beneficiaries
In accordance with new federal requirements, the medical records of Medicare beneficiaries admitted to this hospital may be subject to review by physicians and nurses employed by the Peer Review Organizations of Pennsylvania or its sub-contracting agencies.
Major purposes of this review, which are done independently of this hospital, will be to determine both the need of medical care and whether the hospital services rendered to you by your physician could have safely been administered at a less costly alternate facility, such as a skilled nursing facility. Under the current regulations, if it is determined that your hospital services could have been safely rendered outside of the hospital, Medicare may not reimburse the hospital for all or part of the services you receive. In the event of such determination, you, your physician and the hospital will have the right to appeal this decision. Any information obtained from your hospital chart will remain confidential, subject to federal statute.