Do not wait for every document
Protect the appeal deadline first. Contact the BFCC-QIO as directed on the notice, then continue gathering records and medical support.
Notice and deadline
- Confirm that the patient was admitted as an inpatient, not only placed in outpatient observation.
- Obtain the current Important Message from Medicare, Form CMS-10065.
- Write down the scheduled discharge date and the deadline stated on the notice.
- Confirm the BFCC-QIO name and contact information printed on the current notice.
- Request the fast appeal no later than the scheduled discharge day and before leaving the hospital.
- Record the date, time, channel, confirmation number, and person contacted.
Reasons the discharge may be too soon
- List unresolved symptoms, unstable conditions, or treatment that is still required.
- Explain what medical risk may result from leaving on the scheduled date.
- Identify medication, equipment, transportation, home health, rehabilitation, or caregiver arrangements that are missing.
- Ask the physician or other treating professional to document why continued inpatient care is needed.
- Separate medical concerns from nonmedical preferences so the reviewer can identify the coverage issue quickly.
Documents and information
- Important Message from Medicare and any follow-up copy.
- Planned discharge date and discharge instructions.
- Names of the attending physician, case manager, and hospital unit.
- Relevant test results, orders, therapy notes, or treatment plans available to the patient.
- Written explanation from the patient or representative.
- Representative authorization when another person is handling the appeal.
- Medicare Advantage plan information when applicable.
During the BFCC-QIO review
- Ask for the Detailed Notice of Discharge, Form CMS-10066.
- Ask for copies of the materials sent to the reviewer.
- Stay available for a call from the BFCC-QIO.
- Confirm that the hospital knows the fast appeal was requested.
- Keep a written log of calls, messages, names, and deadlines.
- Ask the hospital to explain any possible financial liability in writing.
After the decision
- Record when and how the decision was delivered.
- If the appeal succeeds, confirm the continued-care plan and what will trigger a later discharge decision.
- If the appeal is denied, note that timely protection generally runs through noon of the next day and ask exactly when patient liability begins.
- Read the decision for any next appeal level and deadline.
- Coordinate a safe discharge plan even while considering further review.
- Keep the notice, decision, proof of submission, and medical support together.