Beginning July 1, 2007, all Medicare beneficiaries, including those in Aetna's Medicare Advantage Plans (HMO, PPO, PFFS), will be able to request immediate Quality Improvement Organization (QIO) review of an inpatient hospital discharge decision. Under this process, the QIO in the state in which services are provided will perform a third-party binding review of the inpatient hospital discharge decision.
For all "timely" Hospital Discharge Appeals, that is, those received before the Medicare member leaves the hospital, the following process will apply:
We will process all "untimely" Hospital Discharge Appeal requests received, that is, those received after midnight on the day of discharge or after the Medicare member has left the hospital. These requests will be subject to the Medicare Expedited Grievance and Appeals Process.
For more information regarding the Hospital Discharge Appeal process, please contact us at 1-866-269-3692.
Please also see Hospital Discharge Appeal Notices on the Centers for Medicare & Medicaid Services (CMS) website.
You will find these specific documents on the CMS website listed above.
Important Message from Medicare (approved 5/2007) (3 pages)
Detailed Notice of Discharge (approved 5/2007)
Resource 04-03-07 (FAQs) (8 pages)
Aetna Medicare Open Plan Quick-Reference Guide (QRG)
Aetna Medicare Open Plan Reimbursement Grid (Updated 11/14/08) (13 pages)
Aetna Medicare Open Plan Terms and Conditions of Payment (Updated 1/12/09) (10 pages)
CMS 1500 Form for physicians
CMS Provider Letter (2 pages)
Medicare Vaccine Information (Updated July 2008) (2 pages)
CMS 1450 Form for institutional providers: hospital, SNF, HHC, etc. (also known as Form UB-04)
What Health Care Providers Need To Know about Private Fee-For-Service Plans (1 page)
"Zero" Copayments for Preventive Services (Updated January 2009) (1 page)