Hospital Discharge Appeals Sample Clauses

Hospital Discharge Appeals. 1. When an Enrollee is being discharged from the hospital, the Contractor must assure that the Enrollee receives a written notice of explanation called the Important Message From Medicare About Your Rights. 2. The Enrollee has the right to request a review by a Quality Improvement Organization (QIO) of any hospital discharge notice. The notice includes information on filing the QIO Appeal. Such a request must be made by noon of the first workday after the receipt of the notice. 3. If the Enrollee asks for immediate review by the QIO, the Enrollee will be entitled to this process instead of the standard Appeals process described above. The Contractor must ensure that the Enrollee receives the Detailed Notice of Discharge (CMS-10066). Note: an Enrollee may file an oral or written request for an expedited 72-hour Contractor Appeal if the Enrollee has missed the deadline for requesting the QIO review. 4. The QIO will make its decision within one full working day after it receives the Enrollee’s request, medical records, and any other information it needs to make its decision. 5. If the QIO agrees with the Contractor’s decision, the Contractor is not responsible for paying the cost of the hospital stay beginning at noon of the calendar day following the day the QIO notifies the Enrollee of its decision. 6. If the QIO overturns the Contractor’s decision, the Contractor must pay for the remainder of the hospital stay. 2.13 Quality Improvement Program A. Quality Improvement (QI) Program The Contractor shall: Deliver quality care that enables Enrollees to stay healthy, get better, manage chronic illnesses and/or disabilities, and maintain/improve their quality of life. Quality care refers to: Quality of physical health care, including primary and specialty care; Quality of behavioral health care focused on recovery, resiliency and rehabilitation; Quality of long term services and supports (LTSS); Adequate access and availability to primary, behavioral health care, specialty health care, pharmacy, and LTSS providers and services; Continuity and coordination of care across all care and services settings, and for transitions in care; and Enrollee experience and access to high quality, coordinated, and culturally competent clinical care and services, inclusive of LTSS across the care continuum. Apply the principles of continuous quality improvement (CQI) to all aspects of the Contractor’s service delivery system through ongoing analysis, evaluation and systematic enhan...
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Hospital Discharge Appeals. 2.12.7.1 When an Enrollee is being discharged from the hospital, the Contractor must assure that the Enrollee receives a written notice of explanation called an Important Message from Medicare About your Rights regarding the right to appeal the discharge decision from an inpatient hospital admission. 2.12.7.2 The Enrollee has the right to request a review by a Quality Improvement Organization (QIO) of any hospital discharge notice. The notice includes information on filing the QIO Appeal. The Enrollee must contact the QIO before he/she leaves the hospital but no later than the planned discharge date. 2.12.7.3 If the Enrollee asks for immediate review by the QIO, the Enrollee is entitled to this process instead of the standard Appeals process described above. The Contractor must ensure that the Enrollee receives the Detailed Notice of Discharge (CMS-10066). Note: an Enrollee may file an oral or written request for an expedited 72-hour Contractor Appeal if the Enrollee has missed the deadline for requesting the QIO review. 2.12.7.4 The QIO will make its decision within one Business Day after it receives the Enrollee’s request, medical records, and any other information it needs to make its decision. 2.12.7.5 If the QIO agrees with the Contractor’s decision, the Contractor is not responsible for paying the cost of the hospital stay beginning at noon of the calendar day following the day the QIO notifies the Enrollee of its decision. 2.12.7.6 If the QIO overturns the Contractor’s decision, the Contractor must pay for the remainder of the hospital stay.
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Hospital Discharge Appeals. 1. When a Dual Eligible Senior Enrollee is being discharged from the hospital, the Contractor must assure that the Enrollee receives a written notice of explanation called Important Notice from Medicare About Your Rights (IM). 2. The Enrollee has the right to request a review by a QIO of any hospital discharge notice. The notice includes information on filing the QIO Appeal. Such a request must be made by noon of the first workday after the receipt of the notice. 3. If the Enrollee asks for immediate review by the QIO, the Enrollee will be entitled to this process instead of the standard Appeals process described above. Note: an Enrollee may file an oral or written request for an expedited 72-hour Contractor Appeal if the Enrollee has missed the deadline for requesting the QIO review. 4. The QIO will make its decision within one full working day after it receives the Enrollee’s request, medical records, and any other information it needs to make its decision. 5. If the QIO agrees with the Contractor’s decision, the Contractor is not responsible for paying the cost of the hospital stay beginning at noon of the calendar following the day the QIO notifies the Enrollee of its decision. 6. If the QIO overturns the Contractor’s decision, the Contractor must pay for the remainder of the hospital stay.
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Hospital Discharge Appeals. 1. When an Enrollee is being discharged from the hospital, the Contractor must comply with the hospital discharge Appeal requirements at 42 C.F.R. §§ 422.620-422.622. 2. The Enrollee has the right to request a review by a Quality Improvement Organization (QIO) of any hospital discharge notice. The notice includes information on filing the QIO Appeal. Such a request must be made by noon of the first workday after the receipt of the notice. 3. If the Enrollee asks for immediate review by the QIO, the Enrollee will be entitled to this process instead of the standard Appeals process described above. The Contractor must ensure that the Enrollee receives the Detailed Notice of Discharge (CMS-10066). Note: an Enrollee may file an oral or written request for an expedited 72-hour Contractor Appeal if the Enrollee has missed the deadline for requesting the QIO review. 4. The QIO will make its decision within one full working day after it receives the Enrollee’s request, medical records, and any other information it needs to make its decision. 5. If the QIO agrees with the Contractor’s decision, the Contractor is not responsible for paying the cost of the hospital stay beginning at noon of the calendar day following the day the QIO notifies the Enrollee of its decision. 6. If the QIO overturns the Contractor’s decision, the Contractor must pay for the remainder of the hospital stay.
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Hospital Discharge Appeals. 2.12.7.1 The Contractor must comply with the hospital discharge Appeal requirements at 42 C.F.R. §§ 422.620-422.622
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Hospital Discharge Appeals. 2.10.4.1. When a Beneficiary is being discharged from the hospital, the ICDS Plan must comply with requirements in 42 C.F.R. §§ 422.620-422.622. 2.10.4.2. The Beneficiary has the right to request a review by a Quality Improvement Organization (QIO) of any hospital discharge notice. The notice includes information on filing the QIO Appeal. The Beneficiary must contact the QIO before he/she leaves the hospital but no later than the planned discharge date.
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Hospital Discharge Appeals. When an Enrollee is being discharged from the hospital, the Contractor must assure that the Enrollee receives a written notice in compliance with requirements in 42 C.F.R. §§ 422.620-422.622.
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Related to Hospital Discharge Appeals

  • AIR DISCHARGES 6.1 Do you have any air filtration systems or stacks that discharge into the air? Yes ( ) No ( ) 6.2 Do you operate any equipment that require air emissions permits? Yes ( ) No ( ) 6.3 Attach copies of any air discharge permits pertaining to these operations.

  • DISCHARGE, SUSPENSION AND DISCIPLINE 10:01 A claim by an employee who has completed probation that he or she has been unjustly discharged shall be treated as a grievance if a written statement of such discharge is lodged by the employee with the Administrator or designate within five (5) days after the employee has received his/her discharge notice. Such grievance will be taken up by the Union at a special meeting with the Administrator. 10:02 It is agreed that the Chairperson of the Union Committee will be notified immediately on the dismissal of an employee in the bargaining unit. Should the Chairperson not be available at the time, a copy of the letter or notice shall be given to a Committeeperson who is available. 10:03 In the event the Employer initiates a disciplinary action against an employee that results in the suspension or discharge of the employee, the following procedure shall be followed: (a) The employee shall be notified in writing, of the action and/or penalty with a copy given to the Chairperson, if the penalty is a suspension. If the penalty is discharge then only the Union (President or his/her designate) need be notified in addition to the employee. (b) In the event the Employer is dissatisfied with the work of an employee and correction discussion has not resolved the problem, the Employer shall notify the employee in writing of the dissatisfaction concerning his/her work within five (5) working days when becoming aware of the incident giving rise to the complaint. This notice shall include particulars of the work performance which led to the complaint. (c) The letter or form given to the employee shall state the complaint or appraisal of results and contain on the bottom thereof a statement to the effect that the employee acknowledges having read the letter or form acknowledging receipt of a copy of the same, and a place for the employee to sign. The employee shall sign the letter or form and a copy shall be given to her. Prior to signing, the employee shall have the opportunity to write her comments. (d) The employee has the right to Union Representation in any proceedings under (a), (b) or (c) above. 10:04 Such grievance shall proceed directly to Step 2 of the grievance procedure and must be presented in writing, dated, and signed within five (5) working days after notice of the discharge was given. 10:05 Only those disciplinary notices that result in a suspension will remain on an employees personnel file for a period of fifteen (15) months. All other disciplinary notices, warnings or statements will be removed and given to the employee after a period of twelve (12) months from the date of the infraction. 10:06 An employee shall, upon written request, be granted the opportunity to view his/her personnel file. It is understood that such request will be granted within seven (7) days or at a time mutually agreed to by the parties. The employee may have a Committeeperson present while viewing their file, if requested. 10:07 The Union Chairperson or a Committeeperson will be present during all warnings, or counselling sessions regarding disciplinary actions of a seniority employee. When an employee is called to an interview and the subject of the interview is discipline, the employee will be so informed by the Employer’s representative when given notice of the interview, and will be advised to have her Union representative present. The interview will not begin or proceed without Union representation. A copy of any warning to be placed in an employee’s file must be copied to the Union Chairperson. Discipline is defined as a written warning, reprimand, suspension, dismissal or other disciplinary action to an employee.

  • DISMISSAL, SUSPENSION AND DISCIPLINE 14 ARTICLE 12 - SENIORITY 16

  • DISCIPLINE/DISCHARGE 25.01 A Shop Xxxxxxx, or in the absence of a Shop Xxxxxxx, another employee in the bargaining unit selected by the employee affected, and in the event the member is a Shop Xxxxxxx, another Shop Xxxxxxx or an official full-time Union Representative, shall be present from the beginning of the meeting when a member of the bargaining unit: a) is given a reprimand which is to be entered on the employee’s personnel file; b) is suspended or discharged. In unusual circumstances, where it is necessary for the Employer to advise an employee by mail of discharge, the Union office will be mailed a copy of such notice. Absence of a Shop Xxxxxxx or Assistant Shop Xxxxxxx or another employee shall not invalidate the discipline, except in exceptional circumstances. 25.02 The affected employee, a Shop Xxxxxxx and the Union, shall be given a copy of any disciplinary notice which is to be entered on an employee's personnel file. The affected employee, the Shop Xxxxxxx, and the Union shall also be given a copy of any discharge notice that is given to an employee. In all cases of discipline or discharge the Employer shall notify the affected employee, and a Shop Xxxxxxx and the Union in writing of the reasons for taking such action. The notice of discipline or discharge shall be given to the affected employee and a Shop Xxxxxxx promptly and a copy of the discipline or discharge notice shall be forwarded to the Union office via fax within two (2) business days (excluding Saturday and Sunday and General Holidays) of the event. 25.03 Employees covered by this Agreement shall have access to their own personnel file, upon written request by the employee involved. Employees shall be able to obtain copies of their personnel file when requested, at the employee's expense. The Employer shall keep only one (1) personnel file per employee. (a) Employee’s written corrective action documentation(s) other than suspension will be taken from an employee’s file after fifteen (15) months should no similar offence have occurred during said period. (b) Employee’s suspension documentation(s) will be taken from an employee’s file after thirty (30) months should no similar offence have occurred during said period. (c) All documentation(s) including corrective action and suspension relating to incident(s) and/or complaint(s) of discrimination or harassment nature shall remain in an employee’s file.

  • Effective Date Term Termination and Disconnection 3.1 Effective Date This Agreement shall become effective upon execution by all Parties.

  • DISCIPLINE, SUSPENSION AND DISCHARGE ‌ 15.01 The Employer shall not discipline, suspend, or discharge an Employee without just cause. 15.02 The Employer and the Union recognize the principle of progressive discipline. 15.03 When an Employee is to be disciplined (e.g., documented oral warning, written warning, suspension, or discharge), such discipline shall only be imposed at a meeting with the Employment Supervisor specifically convened for this purpose. Employees will be given forty-eight (48) hours’ notice, the reason(s) for the meeting and will be advised that they are entitled to be accompanied at this meeting by a Union representative. Such notice shall be in writing. The Union shall be copied on any disciplinary letter within three (3) Business Days of such a meeting. 15.04 A documented oral warning or a written warning shall normally precede imposition of a suspension or discharge, except in the case of gross neglect of duty position abandonment, or gross misconduct. 15.05 Where an Employee has received a disciplinary letter, the Employee may attach comments to the letter and the comments will be placed in their personnel file. (a) A disciplinary letter within an Employee’s personnel file shall be deemed null and void and removed from the file after a twenty-four (24) month period from the date of the letter, provided that no further discipline has been recorded within the period noted above. (b) Where, upon an Employee’s graduation from their program at Queen’s University, a disciplinary letter has been in the Employee’s personnel file for a period of no less than twelve (12) months, such a disciplinary letter shall be removed from the Employee’s personnel file at their request. (c) Article 15.06 (b) does not apply when the Employee registers immediately from one program at Queen’s University into another program at Queen’s University. 15.07 In cases involving allegations of serious misconduct or a threat to the safety of a person or property, as a precautionary measure, the Xxxx (or delegate) of the faculty in which the Employee works may suspend the Employee with pay during an investigation. Within one (1) Business Day from the time of such a suspension, the Employer shall provide the Employee with a letter setting out the allegation or threat with a copy to the Union. The letter will inform the Employee of their right to Union representation in connection with the matter and a meeting will be scheduled between the parties within three (3) Business Days of the above letter being provided. The parties may delay this meeting by written agreement pending the outcome of an investigation. The Employer will complete the investigation and inform the Employee of the results of the investigation, and of any corrective action that has been or will be taken, normally within ninety (90) calendar days of the commencement of the investigation, unless there are extenuating circumstances warranting a longer investigation. During any meetings between the Employee and the Employer during the investigation, the Employee may choose to be accompanied by a Union representative. Where, at the conclusion of the investigation, the allegations that were investigated are unfounded, there shall be no record of the investigation in the Employee’s personnel file. Where the allegations are founded, the Employer may take disciplinary action.

  • DISCHARGE CASES If an employee believes that he has been unjustly discharged he may commence grievance procedure and it will be instituted at Step 2.

  • Good Discharge (a) Any payment to be made in respect of the Secured Liabilities by the Security Agent may be made to the Facility Agent on behalf of the Secured Parties and any payment made in that way shall be a good discharge, to the extent of that payment, by the Security Agent. (b) The Security Agent is under no obligation to make the payments to the Facility Agent under paragraph (a) above in the same currency as that in which the obligations and liabilities owing to the relevant Finance Party are denominated.

  • Termination, Release and Discharge [The] [Each] Subsidiary Guarantor’s Subsidiary Guarantee shall terminate and be of no further force or effect, and [the] [each] Subsidiary Guarantor shall be released and discharged from all obligations in respect of such Subsidiary Guarantee, as and when provided in Section 1303 of the Indenture.

  • Discharge Planning If further care at home or in another facility is appropriate following discharge from the Hospital, Blue Shield will work with the Member, the attending Physician and the Hospital discharge planners to determine the most appropriate and cost effective way to provide this care.

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