Leaving the hospital.

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• Ask whether the hospital stay is inpatient or outpatient observation, and ask for it in writing. If observation services last more than 24 hours, Medicare says the hospital must give a Medicare Outpatient Observation Notice.
• If a skilled nursing stay is the plan, ask how many days counted as inpatient. A qualifying stay is at least 3 days in a row. The day you leave does not count, and observation or emergency-room time before admission does not count.
• Ask the discharge planner which license they mean for the next setting: an inpatient rehabilitation hospital, a nursing home for a short skilled stay, Medicare home health, or help from family. “Rehab” is not a license.
• If you expect Medicare to pay for a skilled nursing facility, ask whether that facility is Medicare-certified and whether a clinician has ordered daily skilled care.
• Ask for a written list of medications, what changed during the stay, and the follow-up appointments. Take the list home.
• Ask what equipment is ordered, who supplies it, and whether someone at home knows how to use it. This directory does not list equipment suppliers, and it does not know what was ordered.
• Ask for “An Important Message from Medicare about Your Rights.” Medicare says a hospital inpatient should get it within 2 days of admission and before discharge. If you think the discharge is too soon, follow that notice no later than the day you are scheduled to leave so a Beneficiary and Family Centered Care Quality Improvement Organization can review it.
• If you are leaving a skilled nursing facility, inpatient rehab, home health, or hospice because covered services are ending, ask for the Notice of Medicare Non-Coverage. It explains the fast appeal for those settings.
• Write down who will be with you at discharge, who to call the first night home, and which papers go with you. Do not put a Social Security number or medical record number on this printed page.
• If payment is still unclear, ask the hospital’s financial counselor and your county Aging and Disability Resource Connection. This page does not decide coverage and does not list a phone number.

A weekly note on discharge and Medicare is at the-next-right-step.com/newsletter.