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How to appeal a hospital discharge (the Medicare fast appeal)

If you are in the hospital and you think you are being sent home too soon, you do not file a claim appeal and wait months. You call a phone number printed on a notice the hospital gave you, by the day you are scheduled to leave, and an independent reviewer decides in about two days while you stay put.

This is a different process from appealing a claim that Medicare has already denied, such as a lab test; for that, see how to appeal a Medicare denial.

The Important Message from Medicare

Medicare.gov: "In a hospital: Within 2 days of your admission and prior to your discharge, you should get a notice called 'An Important Message from Medicare about Your Rights.' This notice is sometimes called the Important Message from Medicare or the IM. If you don't get this notice, ask for it." CMS requires it for everyone on Medicare: "Hospitals are required to deliver the Important Message from Medicare (IM), formerly CMS-R-193 and now CMS-10065, to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients."

If the stay runs long, you get it twice. Medicare.gov: "If the hospital gives you the IM more than 2 days before your discharge day, it must give you a copy of your original, signed IM or give you a new one (that you must sign) before you're discharged." The regulation puts it as: "The notice should be given as far in advance of discharge as possible, but not more than 2 calendar days before discharge."

The notice tells you three things. First, your rights as an inpatient: "You can get Medicare-covered services. This includes medically necessary hospital services. You have a right to know what services are covered." Second, that you can appeal: "If you think you're being discharged from the hospital too soon, you can appeal right away." Third, who to call, in a blank the hospital fills in. The form instructions tell the hospital to "Insert the name and toll-free number of the Quality Improvement Organization (QIO) for the state in which the hospital is located." The notice ends, "Sign below to show you received and understood this notice." The signature shows you received it; the appeal right is described on the same page.

The deadline, in the notice's own words

Medicare.gov: "In a hospital: Follow the directions on the Important Message from Medicare no later than the day you're scheduled to be discharged from the hospital." The notice itself says: "You should ask for an appeal as soon as possible and before you leave the hospital." The regulation: "The request must be made no later than the day of discharge and may be in writing or by telephone."

If you have already left, you have not lost everything. The notice: "After you leave the hospital, you can still appeal. Call your Quality Improvement Organization if you have Original Medicare." The regulation gives a window: a beneficiary "who is no longer an inpatient in the hospital, may request QIO review within 30 calendar days after the date of discharge, or at any time for good cause." But the protection against charges, described below, goes with the on-time request.

What you do

You call. The notice: "To appeal, call your Quality Improvement Organization at:" and then the name and number the hospital wrote in. Medicare.gov describes the reviewer: "With a fast appeal, an independent reviewer, called a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), will decide if your covered services should continue." The notice adds that "Quality Improvement Organizations are independent of Medicare."

Medicare.gov lists what the reviewer does next: "In all cases, the BFCC-QIO will: Ask why you believe coverage for the services should continue; Look at your medical records and the information provided by the hospital (or your plan); Make a decision: In a hospital: Within one day of getting the requested information." The notice says you will get the decision "about 2 days after you ask for an appeal." One line from the regulation worth knowing: "the burden of proof rests with the hospital to demonstrate that discharge is the correct decision."

What happens to the charges while you wait

Medicare.gov: "If you ask for your appeal within this time frame, you can stay in the hospital while you wait to get the BFCC-QIO's decision. You won't have to pay for your stay (except for applicable coinsurance or deductibles)." The notice: "If you appeal before you leave, you'll have coverage while you wait in the hospital for your appeal decision."

The regulation sets the exact cutoff: "If a beneficiary files a request for an expedited determination by the QIO in accordance with paragraph (b)(1) of this section, the beneficiary is not financially responsible for inpatient hospital services (other than applicable coinsurance and deductible) furnished before noon of the calendar day after the date the beneficiary (or his or her representative) receives notification (either orally or in writing) of the expedited determination by the QIO." The Medicare Appeals booklet says the same in plain words: "If you met the deadline for asking for a fast appeal, you won't be responsible for paying the hospital charges (except for applicable coinsurance or deductibles) you have through noon of the day after the BFCC-QIO gives you its decision."

If the reviewer agrees with you: "Medicare will continue to cover your hospital stay as long as medically necessary (except for applicable coinsurance or deductibles)." If it agrees with the hospital, the notice says, "you may have to pay for any services you get after your discharge date," and the regulation's noon-the-next-day line above is where the protection ends.

If you miss the deadline: "you can still ask the BFCC-QIO to review your case, but different rules and time frames apply, and you might be responsible for the cost of the hospital stay past the original day the hospital tries to discharge you." The regulation: a beneficiary who "remains in the hospital past the discharge date ... may be held responsible for charges incurred after the date of discharge or as otherwise stated by the QIO."

The Detailed Notice of Discharge

Once you appeal, the hospital owes you a second notice. Medicare.gov: "In a hospital: The BFCC-QIO will notify the hospital. If you have a Medicare health plan, the BFCC-QIO will notify your plan and the hospital. Then, by noon the day after the BFCC-QIO notifies the hospital (or your plan), the hospital will give you a 'Detailed Notice of Discharge.'" CMS: "A Detailed Notice of Discharge (DND) is given only if a beneficiary requests an appeal. The DND explains the specific reasons for the discharge."

The notice is candid about what it is: "This notice gives a detailed explanation of why your hospital or Medicare health plan has determined Medicare coverage for your hospital stay should end. This notice is not the decision on your appeal. The decision on your appeal will come from your Quality Improvement Organization (QIO)." It has a section for "Detailed explanation of why your hospital stay is no longer covered, and the specific Medicare coverage rules and policy used to make this decision," and it offers copies: "If you would like a copy of the policy or coverage guidelines used to make this decision, or a copy of the documents sent to the QIO, please call us at:". Ask for both. They are what the reviewer is looking at.

Skilled nursing, home health, hospice, and rehab: the Notice of Medicare Non-Coverage

The same fast appeal covers four other settings. Medicare.gov: "You may have the right to ask for a fast appeal if you think your services are ending too soon (or that you're being discharged too soon) from one of these providers: Hospital; Skilled nursing facility (SNF); Home health agency (HHA); Comprehensive outpatient rehabilitation facility (CORF); Hospice care facility."

Outside a hospital the notice has a different name. CMS: "HHAs, SNFs, Hospices, and CORFs are required to provide a Notice of Medicare Non-Coverage (NOMNC) to beneficiaries when their Medicare covered service(s) are ending." Medicare.gov: "You should get a notice called 'Notice of Medicare Non-Coverage' at least 2 days before covered services end. If you don't get this notice, ask for it." The form instructions add that "The two-day advance requirement is not a 48-hour requirement," and the regulation makes the provider pay for late notice: "A provider is financially liable for continued services until 2 days after the beneficiary receives valid notice ... or until the service termination date specified on the notice, whichever is later."

The notice reads: "Medicare Coverage of Your Current [type of] Services Will End on [date]. Your provider and/or health plan determined that Medicare probably won't pay for your ... services after the above date. You may have to pay for any services you get after this date." And: "You have the right to appeal the decision to end Medicare coverage of your services. This means you'll get an independent medical review right away. Your services will continue during the appeal."

The deadline. In the notice's words: "How to ask for an immediate appeal. Ask for the appeal as soon as possible. You must ask for a timely appeal no later than noon of the day before the above date. Make your request to your Quality Improvement Organization (QIO)." Medicare.gov: "Follow the instructions on the 'Notice of Medicare Non-Coverage' no later than noon the day before the termination date listed on the notice." (The regulation frames the same deadline from the other end, as "noon of the calendar day following receipt of the provider's notice of termination"; the notice you are holding is the wording to follow.)

While it decides. The regulation: "When a beneficiary requests an expedited determination in accordance with the procedures required by this section, the provider may not bill the beneficiary for any disputed services until the expedited determination process (and reconsideration process, if applicable) has been completed." The provider then gives you a "Detailed Explanation of Non-Coverage" "by the end of the day that the provider gets the notice from the BFCC-QIO." The reviewer's decision comes "generally no later than two days after the effective date above," per the notice; the regulation says "No later than 72 hours after receipt of the request."

If the reviewer agrees services should end. Medicare.gov: "You won't be responsible for paying for any SNF, HHA, CORF, or hospice services provided before the coverage end date on the 'Notice of Medicare Non-Coverage.' If you continue to get services after the coverage end date, you may have to pay for those services." The notice: "If you stop services by the above date, you'll avoid financial liability."

Who to call: the QIO for your state

Two companies hold the contract, and both changed their names recently. CMS: "The BFCC-QIOs, Acentra Health (formerly Kepro) and Commence Health (formerly Livanta), review complaints and quality of care, and help to improve the effectiveness, efficiency, economy and quality of services provided to people with Medicare." The contract runs from May 2024 to April 2029. Medicare.gov: "Check their websites to make sure you're contacting the right organization for your state."

The number to call is the one printed on your own notice. If you cannot find it, the numbers below are from the CMS directory of BFCC-QIO regions, checked September 27, 2026. Acentra's site says you "can leave a message at Acentra Health's toll-free numbers 24 hours a day, seven days a week" outside its helpline hours, which it lists as "Weekdays: 9:00 a.m. to 5:00 p.m." and "Weekends and Holidays ... 10:00 a.m. to 4:00 p.m." Commence Health's own website still uses the name Livanta in places, including its contact email, so the phone lines may still answer as Livanta.

Websites: acentraqio.com and commencehealthqio.cms.gov. For anything else, Medicare: "1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048."

If you have Medicare Advantage

The hospital fast appeal is the same. The Important Message goes to "Original Medicare beneficiaries and Medicare Advantage plan enrollees," and Acentra's site says: "If you have Medicare (including Medicare Advantage), you have the right to appeal a hospital discharge if you feel too sick to leave." CMS explains why the plan is skipped: "Expedited review requests filed timely bypass the health plan's reconsideration process, and an independent review entity known as a Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) performs the review. If the deadline for requesting a BFCC-QIO review is missed, the enrollee or his or her representative may still ask the health plan for an expedited appeal."

The regulation for plan enrollees mirrors the Original Medicare one: "The request must be made no later than the day of discharge and may be in writing or by telephone," and "the hospital may not charge the enrollee for inpatient services received before noon of the day after the QIO notifies the enrollee of its review determination." One condition to know about, from medicare.gov: Medicare continues to cover the stay "if your plan previously authorized coverage of the inpatient admission, or the inpatient admission was for emergency or urgently needed care. You may need to appeal the denial of coverage for your plan to pay if your plan never authorized the inpatient admission." The Important Message has a second blank for plan enrollees: "If you have a Medicare Advantage plan call your plan at" the plan's name and number.

If the hospital changed you from inpatient to observation

A related fast appeal exists for one specific situation. Medicare.gov: "You can ask for a fast appeal while you're still in the hospital if you were admitted to the hospital as an inpatient and the hospital changed your status to 'outpatient getting observation services.'" The notice for that is the "Medicare Change of Status Notice (CMS-10868)," which the Medicare Appeals booklet says you "should get ... before you leave the hospital." Acentra's site notes it applies "If you have Original Medicare (not a Medicare Advantage Plan)." The older process for appealing past stays closed this year: "Effective January 2, 2026, the 365-calendar day timeframe for filing new patient status appeal requests for eligible hospital stays (the retrospective appeal process) has ended."

Before you call

This is ClaraCover's checklist, built from the rules above.

1. Find the notice. The Important Message from Medicare in a hospital, or the Notice of Medicare Non-Coverage anywhere else. If you never got one, ask for it now; the hospital or provider is required to give it.
2. Read the deadline on it. Hospital: the day you are scheduled to be discharged. Other settings: noon of the day before the end date printed on the notice.
3. Call the number on the notice. A phone call is enough. Write down the date and time you called and who you spoke with.
4. Ask for the detailed notice and the policy. The Detailed Notice of Discharge (or Detailed Explanation of Non-Coverage) must come to you, and it offers a copy of the coverage rule and the records sent to the reviewer.
5. Tell the reviewer why. The reviewer will "Ask why you believe coverage for the services should continue." Have your reasons, and ask your doctor whether they will speak to it.
6. Someone can call for you. The rules speak of the request coming from "the enrollee or his or her representative." A family member at the bedside can pick up the phone.

Sources

• Medicare.gov: Fast appeals
• Medicare.gov: Appeals (overview)
• Medicare.gov: Medicare Appeals (booklet 11525, April 2026), section 5
• CMS: Important Message from Medicare (CMS-10065) and Detailed Notice of Discharge (CMS-10066)
• CMS: Important Message from Medicare, form and instructions (ZIP; form expires 03/31/2029)
• CMS: Detailed Notice of Discharge, form (ZIP; expires 03/31/2029)
• CMS: Notice of Medicare Non-Coverage (CMS-10123) and Detailed Explanation of Non-Coverage
• CMS: Notice of Medicare Non-Coverage, form (ZIP; effective January 2025, expires 11/30/2027)
• CMS: Notice of Medicare Non-Coverage, instructions
• eCFR: 42 CFR 405.1205, notifying beneficiaries of hospital discharge appeal rights
• eCFR: 42 CFR 405.1206, expedited determination procedures for inpatient hospital care
• eCFR: 42 CFR 405.1200, notifying beneficiaries of provider service terminations
• eCFR: 42 CFR 405.1202, expedited determination procedures for provider service terminations
• eCFR: 42 CFR 422.622, requesting immediate QIO review of a hospital discharge (Medicare Advantage)
• CMS: Beneficiary and Family Centered Care Quality Improvement Organizations
• CMS: BFCC Directory (BFCC-QIO map for the 13th scope of work, PDF)
• CMS: Quality Improvement Organizations program
• Acentra Health BFCC-QIO
• Commence Health BFCC-QIO
• CMS: BFCC-QIO review for Medicare health plan enrollees
• Medicare.gov: Appealing a hospital status change
• CMS: Original Medicare (Fee-for-Service) appeals

Checked September 27, 2026. This page explains published Medicare rules. It is not medical, legal, or insurance advice, does not say whether you are well enough to leave, and cannot tell you how a reviewer will decide your case; the number on your own notice, your doctor, and Medicare can help with that. Phone numbers and contractor names are as published by CMS on the date above and can change. ClaraCover has no relationship with any hospital, provider, plan, or contractor.