Medicare and Medicaid
Important Medicaid Re-determination Update
On April 1st, Medicaid (MassHealth in Massachusetts) returned to its normal annual renewal process. If Medicaid has enough information to confirm your eligibility, your coverage was renewed automatically. If Medicaid was not able to confirm your eligibility automatically, you will receive a renewal form in a colored envelope (blue in Massachusetts, yellow in New Hampshire) to the mailing address on file. If you receive any communication from Medicaid in the mail, do not ignore it, act now to avoid disruption or loss of coverage.
- As a Medicare patient, you have the right to receive all the care necessary to properly diagnose and treat your illness or injury. Also, in accordance with Federal Law, your discharge will be determined solely by your medical needs.
- You have the right to be fully informed about decisions affecting your Medicare coverage payment for your hospital stay and for any treatments and services to follow your stay.
- You have the right to request the services of a Peer Review Organization for any written Notice of Non-Coverage from Medicare or the mental center. Peer Review Organizations are groups of doctors empowered by the Federal Government to review medical necessity, appropriateness, and quality of treatment furnished for Medicare patients. To request Peer Review Organization service, contact the following:
Massachusetts Peer Review Organization (MassPRO)
235 Wyman Street
Waltham, MA 02154-1231
Division of Healthcare Quality
Medicaid Fraud Control
Department of Public Health
Nantucket Cottage Hospital cannot charge you unless we provide you with a Notice of Non-Coverage. A non-coverage issue should be discussed with your doctor first. If both the hospital and your doctor disagree with the issue of non-coverage, a Peer Review Organization can be provided.
If you are a member of a Medicare Contracting Health Maintenance Organization (HMO), here is some additional information.
According to Federal law, any decision made by your HMO or the hospital to discharge you must be based solely on your medical need and not on any method of payment. Your attending physician must always be in agreement with the decision to discharge you or to transfer you to a lower level of care.
If you think you are being asked to leave the hospital too soon, ask your HMO for a written Notice of Non-Coverage immediately, if you have not already received one. You must have this notice in order to request a review by the Peer Review Organization.
If you ask for immediate review by the Peer Review Organization, it will replace the regular appeals process described in your HMO Evidence of Coverage.
How does this affect you financially?
If you request immediate review by the Peer Review Organization, you will not be financially responsible for hospital charges until noon of the day following your receipt of the Peer Review Organization review decision.
If you are dissatisfied with the Peer Review Organization’s decision, you may request a reconsideration of your case immediately upon receipt of that decision by contacting the Peer Review Organization by telephone or in writing. Since the Peer Review Organization has already reviewed your case once, the hospital is permitted to begin billing you for the cost of your stay beginning at noon of the day following receipt of the first Peer Review Organization decision.