Anonymous wrote:services already rendered v requested services? My MiL was hastily discharged last summer from the hospital and had to return two days later as the infection was rapidly spreading rather than having been contained. Medicare is refusing to cover her expenses from the second stay. Love any insights on what to do, including if there is a difference in an appeal when the services have already been rendered.

Also appreciate any links. Read the Medicare page, but not clear as it seems like the info are for requested services.

Find the number for your DC or state Health Insurance Assistance Program and ask them:

https://www.shiphelp.org/

Maybe the hospital is ripping you off.

DRG means diagnosis related group. Under traditional Medicare, a hospital is paid based on a DRG. So if a patient is discharged earlier than expected for this Sarah, the hospital makes money. If the patient is discharged on time, the hospital breaks even. If the patient is discharged later than expected, the hospital loses money. This led to pushing patients out early. To combat this, a provision was added that is a patient was readmitted within a certain short period after discharge, the hospital got no further pay.

I don’t know if this applies to your situation. I’d contact billing. Problem is that not being the patient it can be hard to get them to talk to you.

PP, thanks for your reply. The hospital is not taking care of it and may have already sent her bill to collections.

DYK where I may be able to find that info?

Also - is DRG = discharge?

Thx again.

Isn’t the hospital taking care of this? Typically a Medicare operates on a DRG payment schedule. If the readmission is related to the original diagnosis and is too close to the discharge, there is no payment due because the hospital already received payment for the services.

services already rendered v requested services? My MiL was hastily discharged last summer from the hospital and had to return two days later as the infection was rapidly spreading rather than having been contained. Medicare is refusing to cover her expenses from the second stay. Love any insights on what to do, including if there is a difference in an appeal when the services have already been rendered.

Also appreciate any links. Read the Medicare page, but not clear as it seems like the info are for requested services.