After a 911 Call or ER Visit: Understanding Hospital Discharge

You have appeal rights

Medicare requires hospitals to give an “Important Message from Medicare” notice near admission and again before discharge, explaining your right to appeal if you think it’s happening too soon. If you disagree with a discharge date, contact the number on that notice — a BFCC-QIO reviewer — by midnight of the planned discharge day. While the appeal is pending, Medicare keeps covering the stay at no extra cost, and a decision typically comes within a day. The same right, with a similar deadline, applies when Medicare-covered skilled nursing or home health is ending, via a “Notice of Medicare Non-Coverage.” Photograph or save these notices the moment you get them — they have the exact deadline and phone number printed on them.

Start talking to the discharge planner on day one

Every hospital has a discharge planner or case manager, and their job is supposed to start near admission, not the day before leaving. Federal rules also require the hospital to share standardized, comparable data on nearby skilled nursing facilities and home health agencies — matched to your actual preferences (location, specific therapy needs, dementia care) — not just hand you a generic list. Ask for this early, and don’t wait to be offered it.

Rehab, assisted living, or home health — they’re not the same

• Skilled nursing (SNF) rehab is Medicare-covered short-term care, usually requiring a prior qualifying inpatient hospital stay. Coverage is full for the first 20 days, then a daily copay applies through day 100, then it’s the family’s cost. Coverage also ends early if the person stops making rehab progress — ask directly what “progress” means for the specific plan.
• Assisted living (RCFE) is custodial care — help with daily activities, not medical treatment — and Medicare does not cover it at all, regardless of medical need. This is the single most common point of confusion families hit.
• Home health covers skilled, intermittent nursing or therapy visits if a doctor certifies the person is homebound — it does not cover ongoing custodial help like bathing or meal prep on its own.

Questions to ask before discharge

• Is this placement skilled (Medicare-covered) or custodial (private pay) — and who made that determination?
• What’s the specific date Medicare coverage is expected to end?
• If we think this is too soon, who do we call today, and what’s our deadline?
• If the facility we want doesn’t have a bed today, what happens — do we wait, or take whatever’s open?

The first week after any transition — hospital to home, hospital to rehab, rehab to home — is the highest-risk window for a setback or readmission. Line up a follow-up appointment and know who to call before you leave the building, not after something goes wrong.