The prospective fast-appeal deadline is before release from the hospital. Follow the current CMS-10868 notice and contact the BFCC-QIO listed on it. A late request may still be reviewed, but the special billing protection does not apply.
1. Confirm that this is the correct appeal route
This procedure is for an Original Medicare patient who was formally admitted as a hospital inpatient and was later reclassified by the hospital as an outpatient receiving observation services. It is not the ordinary inpatient discharge appeal, a Medicare Advantage plan appeal, or an appeal of a processed claim shown on a Medicare Summary Notice.
Federal rules limit the fast patient-status appeal to people who meet all the required conditions. In addition to the admission and reclassification, either the person was not enrolled in Medicare Part B during the hospitalization, or the hospital stay lasted at least three consecutive days but fewer than three of those days counted as inpatient days under the Medicare skilled nursing facility rule.
2. Read the Medicare Change of Status Notice
The hospital uses the Medicare Change of Status Notice, Form CMS-10868, to tell an eligible beneficiary about the change and the appeal process. The hospital must provide the notice as soon as possible after the eligibility conditions are met and no later than four hours before release.
The notice explains how the change can affect hospital charges and possible Medicare coverage for later skilled nursing facility care. It also identifies the BFCC-QIO that handles the hospital's area. Do not rely on an old phone number or a notice from another hospital.
3. Contact the BFCC-QIO before release
Submit the request by telephone or in writing to the BFCC-QIO named on the MCSN before you are released from the hospital. An authorized representative may request review for the beneficiary. Record the date and time, the organization contacted, the case or confirmation number, and the name of anyone who helped.
If the deadline has already passed, contact the BFCC-QIO promptly. The regulations allow an untimely expedited request, but the decision timeframe is longer and the billing protection described below does not apply.
4. Explain why inpatient Part A coverage should apply
The QIO reviews whether the hospital properly changed the patient from inpatient to outpatient observation status. Explain facts that support continued inpatient classification, including the admission order, the duration and intensity of hospital care, and why the services met Medicare inpatient coverage requirements. Written evidence is allowed but is not required to make the request.
Ask the hospital for access to the records it sends to the QIO. The hospital must provide requested access or copies by the close of business on the first calendar day after the request, although it may charge a reasonable duplication or delivery cost.
5. Wait for the expedited determination
For a timely request, the QIO must make its determination within one calendar day after receiving all requested pertinent information. For an untimely expedited request, the QIO generally has two calendar days after receiving the information. The QIO first notifies the beneficiary by telephone and then sends a written decision explaining the reasons, payment consequences, and further appeal rights.
The hospital must supply the requested records as soon as possible and no later than noon of the calendar day after the QIO notifies it of the appeal.
6. Understand the billing protection
When an eligible beneficiary requests the expedited determination on time, the hospital may not bill the beneficiary for the disputed services until the expedited determination and any timely expedited reconsideration are completed. This protection concerns the disputed status-related services; normal deductibles, coinsurance, and other non-disputed charges may still apply.
A favorable decision may change how the hospital stay is covered under Part A and can affect whether the stay satisfies the inpatient requirement for certain skilled nursing facility coverage. It does not guarantee that every later service will be covered.
7. Request expedited reconsideration if needed
If the first QIO decision is unfavorable, the written notice explains how to request expedited reconsideration. A timely request must be made by telephone or in writing no later than noon of the calendar day after initial notification of the decision. The QIO generally must decide the timely reconsideration within two calendar days after receiving the requested information.
Further review may be available after reconsideration. Follow the decision letter because the next reviewer, filing method, and deadline depend on the stage of the case.
8. Do not confuse the current appeal with the retrospective process
The prospective fast appeal is for an eligible patient who is still at the hospital and receives CMS-10868. A separate retrospective process covers certain earlier hospital stays. The ordinary 365-day filing period for new retrospective requests ended January 2, 2026; later requests require a good-cause explanation and are handled under different rules.
This page provides general procedural information, not medical or legal advice. Contact the BFCC-QIO, Medicare, a State Health Insurance Assistance Program, or an authorized representative for help with an individual case.
Official sources
- Medicare.gov — appealing a hospital patient-status change
- CMS — Medicare Change of Status Notice
- CMS — hospital patient-status appeals
- eCFR — notice and eligibility rules
- eCFR — expedited determination procedures
- eCFR — expedited reconsideration