Medicare service termination appeal checklist

Confirm the appeal route

• Verify that all covered services from an SNF, HHA, hospice, or CORF are ending.
• Use the hospital discharge appeal instead if the dispute concerns leaving an inpatient hospital.
• Use the ordinary Original Medicare or Medicare Advantage appeal route for a denied claim, item, service, or authorization that is not a provider service termination.

Review the notice

• Find the Notice of Medicare Non-Coverage, Form CMS-10123.
• Check the date the notice was delivered and signed.
• Mark the listed coverage end date.
• Copy the BFCC-QIO name, telephone number, and appeal instructions.
• Ask for the current notice if it was not provided.

Request the fast appeal

• Contact the BFCC-QIO no later than noon on the day before the termination date shown on the notice.
• Identify the beneficiary, provider, service setting, and termination date using the information requested by the reviewer.
• Record the date, time, representative, confirmation number, and method used.
• Explain any communication, disability, language, or accessibility support needed for the review.

Prepare the coverage explanation

• Describe the skilled care, therapy, home health, hospice, or CORF services that are still needed.
• Ask the treating clinician to explain why continued services meet Medicare coverage requirements.
• Organize recent evaluations, care plans, progress notes, orders, and discharge or transition concerns that are relevant.
• Separate medical necessity from personal preference or convenience.

Review the DENC and case materials

• Read the Detailed Explanation of Non-Coverage, Form CMS-10124.
• Identify the specific coverage rule and facts used to end services.
• Ask for copies of materials submitted to the BFCC-QIO.
• Correct factual errors promptly through the authorized review channel.

Clarify costs

• Ask whether the provider will continue services after the coverage end date.
• Ask what the estimated cost will be if Medicare does not cover continued services.
• Keep any separate financial-liability notice.
• Do not assume that a timely request guarantees payment for services after the NOMNC end date.

After the decision

• Save the BFCC-QIO decision and delivery date.
• If coverage continues, confirm the new service plan and whether another termination notice may be issued later.
• If the termination is upheld, read the next-level appeal deadline immediately.
• Keep bills and statements that identify services furnished before and after the coverage end date.

Official sources

• Medicare.gov — fast appeals
• CMS — NOMNC and DENC
• eCFR — Original Medicare expedited determinations
• eCFR — Medicare Advantage appeals

Related resources

• Request a fast service termination appeal
• Who pays if services continue?
• Notice of Medicare Non-Coverage
• Hospital discharge appeal checklist
• Centers for Medicare & Medicaid Services