An appeal can occur if you think your Medicare services are ending too soon. For example, if you are in a hospital and you are told you are going to be discharged, but you still feel too sick to leave, you can appeal your discharge through Livanta.
When you have Medicare and are going to be discharged from a health care facility, you will be given a notice in writing called “An Important Message from Medicare”. The notice explains how you can appeal your discharge. To file an appeal, you should call Livanta’s HelpLine.
After Livanta receives the phone call to start the appeal, we contact your health care provider to request your medical record. After we receive the medical record, we send it to a physician reviewer who will review the record. The physician reviewer will then decide whether or not you are healthy enough to be discharged. After the review is complete, you will receive a phone call and letter from Livanta with the decision.
Financial liability is who is going to pay for your hospital care, not including copays and deductibles.
When you file a timely appeal, you are not required to pay for hospital care until the appeal is complete. A timely appeal is when you call Livanta by midnight on the day of discharge to file your appeal.
If Livanta determines that you need to continue to stay in the hospital, Medicare will continue to pay for your care. If Livanta agrees that you are ready for discharge, you will be required to pay starting noon of the day after the determination.
If you appeal to Livanta, you cannot be discharged before the appeal is complete without your consent.
Non-hospital skilled services: When Medicare informs you that skilled services will be terminated, the Notice of Medicare Non-Coverage states that it is possible you will have to pay for the skilled services you receive after the effective date of skilled services ending. If the provider is late in sending the medical records to Livanta, the effective date may be pushed back. In this case you still may have to pay for the services you receive after the new effective date.
In basic terms, skilled care means care that is: •Ordered by a physician •Provided on a daily basis and •Provided by a licensed professional.
Examples of licensed professionals are registered nurses (RN), physical therapists (PT), speech therapists (ST), and occupational therapists (OT).
Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.
Medicare-covered services for skilled care include, but aren't limited to: •Semi-private room (a room you share with other patients) •Meals •Skilled nursing care •Physical and occupational therapy* •Speech-language pathology services* •Medical social services •Medications •Medical supplies and equipment used in the facility •Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF •Dietary counseling
*Medicare covers these services if they're needed to meet your health goal.
When Medicare informs you that skilled services will be terminated, the Notice of Medicare Non-Coverage (NONMC) states that it is possible you will have to pay for the skilled services you receive after the effective date of skilled services ending.
When you file a timely appeal, you are not required to pay for skilled care until the appeal is complete. A timely appeal is when you call Livanta by noon of the day before the effective date on the NOMNC.
A provider may not bill a beneficiary who has filed an appeal on time until the review process is complete.
Livanta’s review findings are protected by federal rules and regulations governing confidentiality. They are not allowable for a malpractice lawsuit and cannot be released under the Freedom of Information Act (FOIA).
LivantaCares Medicare Helpline
The LivantaCares Medicare Helpline app is the fastest way to address your Medicare health care concerns and to receive notifications on the status of your case. It is now GPS enabled to receive timely notification regarding your Medicare rights. There are no phone trees to navigate and the wait time to speak with a specialist is under 30 seconds. You can contact the Medicare Quality Improvement Program with ease. Livanta is a US Government authorized Medicare contractor.