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How Medicare Helps You Prepare for a Hospital Discharge

The hospital can be intimidating, but if you’ve been admitted, there’s a good chance you need the care. Once you’ve been discharged, that’s it, right? You’re done with treatment, it’s time to get back to whatever you were doing. Not so fast! Once you leave the hospital, your recovery and care are only partially complete. Often, you’ll be sent on your way with a set of instructions or prescription drugs that will complete or aid you on your journey to recovery.

If you’re a Medicare beneficiary, you may even get additional guidance, called hospital discharge planning. While this service isn’t always required, it can help you recover from whatever reason put you in the hospital and encourage you to start living your life as successfully as possible.

How Does Medicare Get Involved?

While some doctors will give their patients instructions on what to do after leaving the hospital, the scope and depth of these instructions aren’t always standardized. Medicare beneficiaries can count on this, to some degree, with discharge planning services. The Centers for Medicare and Medicaid Services (CMS) defines discharge planning as, “[a] process used to decide what a patient needs for a smooth move from one level of care to another.” When required, Medicare beneficiaries can rely on a health care professional or social worker to analyze their health care needs after leaving the hospital.

When “required” is an important provision. Just because you’re being treated at a hospital, doesn’t mean that discharge services are required by Medicare. Your patient status decides whether you must get these services. Only inpatient beneficiaries are required to receive hospital discharge planning when they’re leaving the hospital. If you’re an outpatient, discharge planning services are not required across the board, however some individual states do require them for Medicare beneficiaries. To find out if your state is one that requires these services, check with your state health insurance assistance program (SHIP).

This can also make it important to determine whether you’re an inpatient or outpatient while in the hospital. Sometimes, you may think you’re an inpatient, when you’re really in observation status, which technically means you’re an outpatient. Verifying your status, or asking to be admitted to the hospital as an inpatient, may be worthwhile if you anticipate needing Medicare hospital discharge planning. If you are an outpatient, but still want some form of discharge planning, you can follow along below or use Medicare’s discharge planning checklist.

What a Plan Should Cover

Generally speaking, your discharge planning will cover most of the remaining facets of your recovery once you leave the hospital. To briefly summarize what a discharge plan should cover, it’ll be the who, what, where, why, and how of your continuing treatment once you leave the hospital. The primary aspects that this plan will cover include:

  Description
Where to next? Are you going home, to a skilled nursing facility, or elsewhere?
What you can do What can you do to further your recovery (e.g., exercises, bed rest, etc.)?
Any prescription drugs? What prescriptions drugs did you take in the hospital or will you still need?
Is DME needed? Will you need any durable medical equipment at home?
Caregiver instructions Is a loved one or professional caregiver available to help you after you leave the hospital? How can or should they help care for you?

As you can see on the discharge checklist, there are many other factors that should be covered in your plan. If you think something may have been missed, just ask! You are the greatest advocate for your recovery and ongoing treatment, so if you’re worried something has been glossed over, ask as many questions as you need.You can also request any instructions get written down, so you have them available after leaving the hospital.

What Next?

One step of the hospital discharge planning is to decide if you think you’re being discharged too soon. Hospitals are required to give you an Important Message from Medicare, which is a notice that you’re being discharged. If you believe that you’re being discharged too soon, it’s important that you file a discharge appeal as soon as possible. Your right to appeal Medicare decisions allows you to attempt to stay in the hospital longer. Once you’ve submitted the appeal, it’ll be reviewed and discussed by the local Beneficiary and Family Centered Care Quality Improvement Organization.

Besides that step, the only thing left after being discharged is to follow your doctors’ orders. After all, your care in the hospital is only part of your treatment. Once you leave, you become responsible for your treatment and coverage, and mistakes can be common and represent a big problem! This is the greatest advantage of Medicare’s hospital discharge planning. It draws a roadmap for your treatment after you leave the hospital. If you follow this map and stick to the plan, you’ll be well on your way to your destination — recovery!