Medicare wants to ensure that people with Medicare receive care that is medically necessary. Medicare cannot afford to pay for care that is not medically necessary. Therefore, there are times when Medicare will no longer pay for a medical service. Medicare also may not continue to pay for your stay in a healthcare facility. You will be told this in writing. You or your authorized healthcare representative may not agree with this decision. (An authorized healthcare representative is someone you choose to help you with your medical decisions.) You or your representative can get a second opinion. You can request an appeal with Healthcare Quality Strategies, Inc. (HQSI).

You can request an appeal when you are getting services from:

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• Comprehensive outpatient rehabilitation facilities (CORFs)

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• Home health agencies

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• Hospices

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• Hospitals

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• Nursing homes

When your healthcare provider believes a Medicare service is no longer medically necessary, you will receive an official written document. It is A Notice of Medicare Provider Non-Coverage or an Important Message from Medicare. These documents tell you that your healthcare services will end on a certain date. They provide important time frames for requesting an appeal if you think these services are still needed. It is important to act quickly.

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• Call the HQSI Medicare Beneficiary Helpline at 1-800-624-4557. (TTY users should call 1-800-752-8420) Our qualified staff will answer your questions and discuss your situation.

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• HQSI will review your medical record. (A medical record is the documentation of your medical history or case.) We will determine whether payment by Medicare should continue for the days or services in question. We will notify you or your healthcare representative and your healthcare provider of the decision by phone.