What will happen during the BFCC-QIO’s review?
When the BFCC-QIO gets your request within the fast appeal time frame, it will notify the plan and the hospital. Once your plan and the hospital are notified by the BFCC-QIO, your plan or the hospital will provide you a “Detailed Notice of Discharge.” Your plan or the hospital will provide this notice by noon of the day after the BFCC-QIO notifies the hospital. The notice will include:
- Why your services are no longer reasonable and necessary or are no longer covered
- A description of the applicable Medicare coverage rule or policy, including information on how you can get a copy of the policy
- How the applicable coverage rule or policy applies to your specific situation
You can also ask your plan for copies of any of the materials that your plan sent to the BFCC-QIO about your hospital discharge. The BFCC-QIO will look at your medical information provided by the hospital and will also ask you for your opinion. The BFCC-QIO will decide if you’re ready to be discharged within one day of getting the requested information.
