A timely request generally protects you from additional hospital charges during the BFCC-QIO review, except for applicable deductibles or coinsurance. Missing the notice deadline can change both the review route and who pays for the extra stay.
When the protection applies
You must have been admitted as a hospital inpatient and request the expedited review through the BFCC-QIO listed on the Important Message from Medicare. Follow the notice no later than the day of the scheduled discharge and before leaving the hospital.
The hospital should not require you to leave while the timely fast appeal is pending. Keep the notice and proof of when the appeal was requested.
How long the protected period lasts
The BFCC-QIO reviews the record quickly and Medicare.gov states that it makes the hospital decision within one day after receiving the requested information. If the reviewer decides discharge is appropriate, a timely requester generally is not responsible for hospital charges through noon of the day after the decision is delivered, other than normal cost-sharing. Care after that point may be billed to the patient.
What changes if the reviewer agrees with you
If the BFCC-QIO decides the discharge is too soon, Medicare can continue covering the inpatient stay while it remains medically necessary. Medicare Advantage payment can involve an additional question when the plan did not authorize the admission and the admission was not for emergency or urgently needed care.
What changes if the deadline was missed
You may still have review rights, but the fast-appeal payment protection may not apply. Original Medicare and Medicare Advantage use different late-review routes. Contact the BFCC-QIO or the plan immediately and ask the hospital to explain potential charges in writing.
Official sources
- Medicare.gov — fast appeals
- CMS — hospital discharge appeal notices
- eCFR — Original Medicare expedited review
- eCFR — Medicare Advantage immediate QIO review