Patients & Visitors
Medicare and Medicaid
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
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
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.