The fast-review route has a short deadline. A late request may still be reviewed, but the expedited timing and financial protections can change. Contact the BFCC-QIO shown on your current notice rather than relying on an old phone number.
1. Confirm that this appeal covers your setting
This procedure applies when all Medicare-covered services are ending from a skilled nursing facility (SNF), home health agency (HHA), hospice, or comprehensive outpatient rehabilitation facility (CORF). It can apply in Original Medicare and Medicare Advantage.
It is not the hospital inpatient discharge appeal. It also is not automatically the correct route for a reduction in services, the end of only one service while other Medicare-covered services continue from the same provider, a denied claim already shown on a Medicare Summary Notice, or a Medicare Advantage denial issued before care begins.
2. Review the Notice of Medicare Non-Coverage
The provider must use the standardized Notice of Medicare Non-Coverage, Form CMS-10123, when the covered course of services is ending. The notice identifies the coverage end date, when possible financial responsibility begins, the BFCC-QIO contact information, and how to request an expedited determination.
Federal rules generally require delivery no later than two days before the proposed end of services. Special timing rules apply when services are expected to last fewer than two days or when visits in a non-residential setting are spaced more than two days apart. If you did not receive a notice, ask the provider for the current form.
3. Contact the BFCC-QIO by noon
Follow the notice and request the fast appeal no later than noon on the day before the termination date shown on the NOMNC. The BFCC-QIO is the independent Medicare reviewer named on the notice. A request may usually be made by telephone; follow any additional directions printed on the form.
Record the date and time, the organization contacted, the confirmation or case number, and the name of anyone who helped. An authorized representative may act for the beneficiary.
4. Explain why the covered services should continue
Tell the reviewer why ending the services on the listed date may be premature. Focus on the Medicare coverage requirement and the beneficiary’s current need for skilled care, therapy, home health, hospice, or CORF services. Ask the treating clinician or provider to document facts that support continued coverage.
You may submit evidence and ask for copies of materials sent to the BFCC-QIO. Do not send WhatDoIFile a Medicare number, medical records, or other health information.
5. Read the Detailed Explanation of Non-Coverage
After the fast appeal is requested, the provider or Medicare Advantage plan must give the beneficiary a Detailed Explanation of Non-Coverage, Form CMS-10124, by the end of the day it receives notice from the BFCC-QIO. The DENC explains the specific reason services are ending, the Medicare coverage rule or policy being applied, and how that rule relates to the beneficiary’s circumstances.
The CMS form page lists the current NOMNC and DENC downloads as effective January 2025. Use the current CMS page rather than a saved copy because forms and instructions can change.
6. Wait for the independent decision
The BFCC-QIO reviews the medical record, the provider or plan information, and the beneficiary’s explanation. Medicare.gov states that, in these settings, the reviewer generally decides by close of business on the day after it receives the information needed to make the decision.
If the reviewer finds that services are ending too soon, Medicare may continue to cover medically necessary SNF, HHA, CORF, or hospice services, subject to normal deductibles or coinsurance. If the reviewer agrees that services should end, the beneficiary is not responsible for services furnished before the coverage end date on the NOMNC, but may have to pay for services received after that date.
7. Review further appeal rights
The decision notice explains the next review level and its deadline. Medicare Advantage rules provide a reconsideration route after an independent review entity upholds a termination. Original Medicare also has additional review procedures. Follow the decision you actually receive because the route and deadline depend on the coverage arrangement and the reviewer’s decision.
This is general procedural information, not medical or legal advice. Contact the BFCC-QIO, the Medicare plan, Medicare, or an authorized representative for help with an individual case.
Official sources
- Medicare.gov — fast appeals
- CMS — NOMNC and DENC forms and instructions
- CMS — Beneficiary Notices Initiative
- eCFR — Original Medicare provider service termination notices
- eCFR — Medicare Advantage fast-track service termination appeals