Request a fast Medicare hospital discharge appeal

Act before leaving the hospital

The fast-appeal protections depend on following the deadline and contact instructions in your current notice. If you miss the deadline, another review may still be available, but different payment and timing rules can apply.

1. Confirm that this is the hospital discharge appeal

This procedure is for a person enrolled in Medicare who was admitted as an inpatient and is told that the hospital plans to discharge them. It can apply to Original Medicare and Medicare Advantage enrollees. It is different from appealing a denied claim, a Medicare Advantage prior-authorization decision, a Part D drug decision, or a change from inpatient status to outpatient observation status.

2. Get the Important Message from Medicare

The hospital should provide the Important Message from Medicare, often called the IM, within two days of inpatient admission and before discharge. If the first notice was delivered more than two days before the planned discharge date, the hospital must provide a follow-up copy or a new notice before discharge.

The current CMS notice is Form CMS-10065. It explains the discharge date, appeal rights, possible financial responsibility, and how to contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) serving the state. Ask the hospital for the notice if you did not receive it.

3. Contact the BFCC-QIO by the notice deadline

Follow the directions on the IM no later than the day you are scheduled to be discharged and before you leave the hospital. Use the telephone number or other channel printed on the notice. The BFCC-QIO is an independent Medicare reviewer; the organization serving a particular state may change, so use the current notice rather than an old contact list.

Record the date and time of the request, the name of the organization contacted, the confirmation or case number, and the name of any person who helped. A patient representative may request the review when authorized to act for the beneficiary.

4. Explain why continued inpatient care is medically necessary

Be ready to explain why discharge on the planned date may be unsafe or premature. Useful facts can include unresolved symptoms, treatment that is still required, inability to manage essential care after discharge, missing equipment or services, or a discharge plan that has not been arranged. Ask the treating clinician to document the medical reasons when appropriate.

Do not send WhatDoIFile any Medicare number, medical records, or personal health information. Submit information only through the hospital, the BFCC-QIO, the Medicare plan, or another authorized channel.

5. Review the Detailed Notice of Discharge

After the appeal begins, the hospital or Medicare Advantage plan must provide a Detailed Notice of Discharge, current Form CMS-10066. Medicare.gov states that, for a hospital appeal, this notice is generally provided by noon of the day after the BFCC-QIO notifies the hospital or plan. It explains the specific reason the hospital or plan believes inpatient services should end and how the coverage rule applies to the case.

You may ask for copies of the materials sent to the BFCC-QIO and may provide your own information. Stay available because the reviewer may need to speak with you or your representative quickly.

6. Wait for the independent decision

The BFCC-QIO reviews the medical records and the information from the beneficiary, hospital, and, when applicable, Medicare Advantage plan. Medicare.gov states that the BFCC-QIO makes the hospital decision within one day after receiving the requested information.

If the appeal was requested on time, you may remain in the hospital while waiting for the decision and generally are not responsible for hospital charges during that protected period other than applicable deductibles or coinsurance.

7. Understand the decision and next step

If the BFCC-QIO decides that discharge is too soon, Medicare coverage can continue while inpatient care remains medically necessary. For a Medicare Advantage enrollee, separate plan-authorization rules can affect payment when the admission was not previously authorized and was not emergency or urgently needed care.

If the BFCC-QIO agrees with the discharge, Medicare.gov says that a timely requester generally is protected from hospital charges through noon of the day after the decision is delivered, apart from normal cost-sharing. Services after that point may become the beneficiary’s responsibility. The decision notice explains any further review rights.