Quality Improvement Organization

What it means

Every state has one under contract to Medicare. Its number appears on the notices a hospital, nursing facility, home health agency or hospice must give before cover ends.

A request may be made in writing or by telephone, and the provider — not the family — carries the burden of proving that discharge or termination is correct.

A hospital discharge review is decided within one calendar day of the organization receiving what it asked for; a provider termination review within 72 hours.

Why it matters

It is the fastest and cheapest route a family has to challenge a decision that is about to happen, and almost nobody is told it exists.

Asking on time also limits what the family can be billed for the disputed days.

When you are likely to meet it

• When a hospital says a parent is being discharged and the family thinks it is unsafe.
• When a nursing facility, home health agency or hospice gives notice that Medicare cover is ending.

Related terms

• Critical access hospitalA small rural hospital with its own Medicare designation — and the same discharge and appeal rules as any other.
• Discharge plannerThe hospital staff member responsible for what happens after a stay ends.
• Home healthSkilled clinical care delivered at home, ordered by a doctor. Medicare may pay for it while the clinical need lasts.
• HospiceCare that focuses on comfort rather than cure, for someone expected to live six months or less.
• Maintenance coverageMedicare cover for skilled care that will not improve the patient, but prevents deterioration or preserves what they have.
• Observation statusBeing in a hospital bed as an outpatient, which changes what Medicare pays for afterwards.
• Skilled nursing facilityA facility providing nursing and rehabilitation care that has to be delivered by licensed clinical staff — not the same thing as a nursing home in the everyday sense.

Official sources

The authority this page describes, at the agency that publishes it. Sahvelo does not restate a rule from a secondary source.

• Medicare — file an appeal (opens in a new tab)

Sahvelo guidance that uses this

• Leaving hospital
• Rehab and skilled nursing