If a QIO appeal is lost, what happens next?

• A. The hospital must absorb the charges immediately.
• B. The patient is discharged from hospital immediately.
• C. The QIO will determine the date the patient becomes responsible for the charges. If patient still admitted, may request redetermination.
• D. The QIO decision cannot be challenged.

Answer: (C)

When a QIO appeal is decided against you, the next step is that the patient’s responsibility for charges is set by the QIO. The QIO identifies the date on which the patient becomes financially responsible for the charges. If the patient is still in the hospital when this determination is issued, a redetermination can be requested to review or adjust that date or the decision. The hospital isn’t required to absorb the charges, and the patient isn’t automatically discharged because of the QIO decision. There is still a path to challenge the outcome through the redetermination process.