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Medicare appeals
Last updated: 26 September 2026
When a hospital says you must leave, or Medicare-covered skilled nursing, home health, rehabilitation, or hospice care is ending, the appeal clock can be very short. The written notice tells you which fast-appeal path applies. Call first, then gather records.
Bottom Line
A Medicare fast appeal asks an independent reviewer to decide whether covered care is ending too soon. For a hospital discharge, follow the Important Message from Medicare no later than the scheduled discharge day. For a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice, follow the Notice of Medicare Non-Coverage by noon the day before the termination date. Medicare explains both deadlines in its current fast appeal guidance.
Best first step: Call the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) number on the notice now. Do not wait for a doctor letter, family meeting, or complete medical record before opening the appeal.
Need Help Right Now?
If discharge or coverage ends today or tomorrow, call now. Tell the reviewer the notice title, the discharge or termination date, and that you want a Medicare fast appeal. If you cannot find the notice, call Medicare at 1-800-633-4227 (TTY 1-877-486-2048) or use the current Medicare contact page.
If staff say you cannot appeal, ask for the written notice anyway and call the BFCC-QIO. A missed deadline does not always erase appeal rights, but it can increase the risk that you will owe for continued care.
Start Here
- Find the notice. Hospital inpatients usually need the Important Message from Medicare. SNF, home health, CORF, and hospice terminations generally use the Notice of Medicare Non-Coverage.
- Call before the deadline. Use the BFCC-QIO number printed on the notice. Say you are requesting a fast appeal.
- Build the medical record. Ask the doctor, nurse practitioner, therapist, nurse, or case manager to document the skilled or inpatient care that is still medically needed.
Quick Reference: Which Notice and Deadline?
| Situation | Notice | Act by | Key protection |
|---|---|---|---|
| Hospital inpatient discharge | Important Message from Medicare (IM) | No later than the scheduled discharge day | If timely, you may stay during the BFCC-QIO review without hospital charges beyond normal Medicare cost-sharing until the protected period ends. |
| SNF, home health, CORF, or hospice coverage ending | Notice of Medicare Non-Coverage (NOMNC) | Noon the day before the termination date | If the reviewer agrees care should end, you are not responsible for covered services before the NOMNC end date. |
| Home health reduces some visits or supplies | HHCCN or ABN may apply | Read the notice immediately | A partial plan-of-care change is not always the same as ending all covered home health services. |
| Hospital changes inpatient status to observation | Medicare Change of Status Notice | Use the notice instructions | This is a separate status-appeal path that can affect hospital costs and later SNF coverage. |
Hospitals must give the IM to Medicare inpatients, and CMS lists the current IM and Detailed Notice of Discharge on its hospital notice page. CMS lists the NOMNC and Detailed Explanation of Non-Coverage on its service termination page.
What Has Changed
This September 2026 review confirms current BFCC-QIO contractors and phone numbers, adds the urgent next-step deadline after an unfavorable decision, and explains that lack of improvement alone does not end skilled-care coverage when skilled maintenance care is still medically necessary.
It also separates home health reductions and exhausted SNF benefit days from the ordinary NOMNC fast-appeal path.
How Medicare Fast Appeals Work
A fast appeal is an urgent coverage review. The reviewer is independent of the hospital, nursing facility, home health agency, rehabilitation provider, or hospice. CMS says BFCC-QIOs handle these reviews and quality-of-care concerns; the current contractors are Acentra Health and Commence Health. See the official BFCC-QIO overview.
The question is not simply, “Would I rather stay?” The central question is whether the Medicare-covered level of care should continue under Medicare rules. Medical facts matter most: what skilled service is still needed, what condition remains unstable, what treatment or monitoring is required, and why a lower level of care cannot safely and effectively meet that need now.
Discharge safety still matters, but it is not identical to Medicare coverage. A person can have serious problems at home and still no longer meet the rules for inpatient hospital care. Keep the fast appeal focused on covered medical need while also asking the discharge planner to solve equipment, medication, transportation, home health, caregiver, or placement problems.
For a broader Medicare Advantage denial, use the plan notice and the Medicare Advantage appeals guide.
Notice Rules That Matter
Hospital inpatient: Medicare says you should get the Important Message from Medicare within two days of admission and before discharge. If the hospital gave it more than two days before discharge, it must give you a follow-up copy of the signed IM or a new one before discharge. If you start a timely appeal, the hospital then provides a Detailed Notice of Discharge explaining why it believes inpatient care should end.
SNF, home health, CORF, or hospice: Medicare says you should get a NOMNC at least two days before covered services end. After you request the fast appeal, the provider gives a Detailed Explanation of Non-Coverage explaining the coverage rule and how it applies to you.
Home health reduction: When all covered home health services are ending, the NOMNC is the important fast-appeal notice. When only part of the plan of care changes, an HHCCN or Advance Beneficiary Notice may apply instead. Medicare explains these differences on its home health protections page. For more detail on payment-warning forms, see the GFS Medicare ABN guide.
If the notice never arrived: Ask for it by name, document whom you asked and when, and call the BFCC-QIO or Medicare. Do not let a missing paper become the reason you wait.
Build the Strongest Case Quickly
Open the appeal first. Then gather the clearest facts. You do not need a perfect binder before calling.
| What to show | What to ask for | Why it helps |
|---|---|---|
| Current skilled or inpatient need | Short clinician note naming the service still required | Connects the appeal to Medicare coverage criteria. |
| Recent change or instability | Nursing notes, vital trends, new orders, medication changes, wound notes | Shows why care may still require skilled monitoring or treatment. |
| Function and therapy need | Latest PT, OT, or speech notes and transfer/walking status | Shows whether skilled therapy remains necessary. |
| Why lower care is not enough | Discharge plan, equipment plan, home health orders, caregiver limits | Helps distinguish a realistic lower level of care from one that cannot meet the documented need. |
Medicare says you may ask for copies of materials sent to the BFCC-QIO. Ask for the DND or DENC, recent clinical notes, therapy notes, orders, medication list, and the coverage policy the provider says applies.
Do Not Accept “You Stopped Improving” as the Whole Explanation
For skilled nursing facility, home health, and outpatient therapy benefits, Medicare coverage does not depend only on whether the patient is improving. CMS’s maintenance coverage guidance says skilled nursing or therapy may be covered when skilled care is needed to maintain the person’s condition or to prevent or slow decline, as long as all other Medicare coverage requirements are met.
If someone says, “Medicare stops because you reached a plateau,” ask a more specific question: “Does the patient still need skilled nursing or skilled therapy to maintain function, prevent or slow decline, or provide care safely?” Medicare’s current SNF coverage page also states that skilled care may be needed to improve or maintain a condition, or prevent or delay worsening.
This rule does not make every long-term stay covered. The care must still meet the other Medicare requirements and must truly require skilled personnel.
Deadlines, Review Timing, and Bill Risk
Hospital: If you make the fast-appeal request on time, Medicare says you can remain in the hospital while the BFCC-QIO reviews the discharge. If the reviewer agrees that discharge is appropriate, you generally are protected from hospital charges, other than normal Medicare cost-sharing, through noon of the day after the BFCC-QIO gives its decision. Services after that point may become your responsibility.
Other covered settings: If the BFCC-QIO decides the SNF, home health, CORF, or hospice services should end, Medicare says you are not responsible for covered services provided before the coverage end date on the NOMNC. Continued services after that date may become your responsibility.
How fast is the review? Medicare says the BFCC-QIO generally decides hospital cases within one day after getting the requested information. For other settings, it generally decides by close of business the day after it gets the information it needs.
Special Situations That Change the Route
SNF says you are out of benefit days
Running out of available Part A SNF benefit days is different from a medical-necessity termination. CMS’s current claims manual treats exhaustion of SNF benefit days as a technical benefit requirement rather than a medical-necessity decision. Ask the SNF exactly why Medicare payment is ending: lack of medical necessity, custodial care, or exhausted benefit days. The answer can change which notice and appeal route you need.
Hospital changes inpatient status
If you were admitted as an inpatient and the hospital changes you to outpatient observation, there is a separate fast status-appeal process. Medicare explains the current rules on its hospital status appeal page. This can affect your hospital bill and later SNF coverage. The GFS observation status guide explains the practical SNF problem.
Home health cuts visits
If only some home health services are being reduced, ask whether the agency is using an HHCCN, ABN, or NOMNC. The GFS home health denial guide covers this narrower problem.
Medicare Advantage is involved
Some Medicare Advantage discharge and service-termination cases use BFCC-QIO review, while other denials use the plan appeal system. Follow your notice and Medicare’s health plan appeals page.
If the First Fast Appeal Is Denied
Read the decision immediately. The next expedited review deadline can be extremely short. CMS’s claims manual states that a timely expedited reconsideration request in these fast-review tracks may be due no later than noon of the calendar day after you receive the initial decision. Follow the decision letter because the exact reviewer and route depend on the setting and coverage type. See the official CMS appeal manual.
If you miss the first fast-appeal deadline, call anyway. Medicare says hospital patients can still ask the BFCC-QIO to review the case, but different timing and payment rules apply. In other service-termination cases, missed-deadline options depend on whether you have Original Medicare or a Medicare health plan.
Keep planning for the next care setting while the appeal is pending. Ask what can be arranged now: home health, equipment, medication help, transportation, outpatient therapy, hospice when appropriate, caregiver training, or a safer facility transfer. If a later claim or bill is denied, the GFS Medicare Summary Notice guide can help you identify the reason and appeal information.
Official Help and BFCC-QIO Contacts
Use the number on your IM or NOMNC first. Acentra Health serves Regions 1, 4, 6, 8, and 10; Commence Health serves Regions 2, 3, 5, 7, and 9. Confirm numbers on the Acentra contact page or Commence contact page.
| Region | Contractor | States and territories | Phone |
|---|---|---|---|
| 1 | Acentra | CT, ME, MA, NH, RI, VT | 1-888-319-8452 |
| 2 | Commence | NJ, NY, PR, VI | 1-866-815-5440 |
| 3 | Commence | DE, DC, MD, PA, VA, WV | 1-888-396-4646 |
| 4 | Acentra | AL, FL, GA, KY, MS, NC, SC, TN | 1-888-317-0751 |
| 5 | Commence | IL, IN, MI, MN, OH, WI | 1-888-524-9900 |
| 6 | Acentra | AR, LA, NM, OK, TX | 1-888-315-0636 |
| 7 | Commence | IA, KS, MO, NE | 1-888-755-5580 |
| 8 | Acentra | CO, MT, ND, SD, UT, WY | 1-888-317-0891 |
| 9 | Commence | AZ, CA, HI, NV, AS, GU, MP | 1-877-588-1123 |
| 10 | Acentra | AK, ID, OR, WA | 1-888-305-6759 |
Free Medicare counseling: Use the SHIP locator or call 1-877-839-2675. The GFS SHIP and SMP guide explains this free help.
Local aging help: The Eldercare Locator can connect you to aging services and ombudsman programs at 1-800-677-1116.
Safety complaint: This is separate from the appeal. Use your State Survey Agency or Medicare’s complaint process.
Representative: Medicare lists the CMS-1696 form on its appeal forms page.
Phone Scripts You Can Use
Opening the fast appeal
“I am requesting a Medicare fast appeal because the notice says my hospital stay or covered services will end on [date]. Please open the case now and tell me the deadline for any information you need from me.”
Asking the clinician
“Can you document what skilled or inpatient care is still medically necessary, what could happen if it stops now, and why a lower level of care cannot safely meet that need yet?”
When the notice is missing
“I was told Medicare-covered care is ending, but I do not have the written appeal notice. Please give me the notice that applies and tell me the coverage end date. I am also calling the BFCC-QIO today.”
After an unfavorable decision
“I disagree with the fast-appeal decision. What is the exact deadline for the next expedited review, who receives it, and when could I become responsible for payment?”
Common Mistakes to Avoid
- Waiting for a family meeting. Open the appeal before the deadline; meetings and records can follow.
- Relying on verbal statements. Ask for the notice by name and keep a copy.
- Arguing only that home is unsafe. Also explain the Medicare-covered skilled or inpatient care that is still medically necessary.
- Accepting “no improvement.” Ask whether skilled maintenance care is still needed.
- Confusing benefit days with medical necessity. In a SNF, ask why Medicare payment is ending.
- Missing the second deadline. After an unfavorable decision, the next expedited request can be due by noon the next calendar day.
- Mixing notices. An IM, NOMNC, HHCCN, ABN, and status-change notice lead to different paths.
- Stopping discharge planning. Build a backup plan even while the appeal is pending.
Document Checklist
Gather what you can, but do not delay the first call if some records are missing.
- Important Message from Medicare or Notice of Medicare Non-Coverage.
- Detailed Notice of Discharge or Detailed Explanation of Non-Coverage, if already issued.
- Medicare card and Medicare Advantage plan card, if applicable.
- Discharge date or coverage termination date.
- Recent doctor or practitioner note supporting continued covered care.
- Nursing, therapy, wound, medication, or home health notes that show current need.
- Current orders and treatment plan.
- Discharge plan, equipment plan, transportation plan, and home health orders.
- Names and phone numbers of clinicians and case managers.
- A call log with dates, times, names, case numbers, and what each person said.
- Any denial or BFCC-QIO decision letter and the envelope or electronic timestamp showing when you received it.
Reality Checks for Families
A fast appeal is not a guarantee. The reviewer can agree that care should end. Make the backup plan at the same time.
Coverage and discharge planning are related but different. A person may no longer qualify for hospital-level care and still need significant help at home. Ask who will provide that help before leaving.
Caregiver availability matters to planning, but not every caregiver gap proves Medicare coverage. Be specific about what medical or skilled need cannot be met at the lower level of care.
Keep later billing papers. A fast appeal may decide whether care should continue, while later claim and payment appeals can involve different notices and deadlines.
Resumen en Español
Actúe el mismo día. Una apelación rápida de Medicare pide una revisión urgente cuando un hospital quiere darle de alta o cuando ciertos servicios cubiertos terminan demasiado pronto.
En el hospital, siga el Important Message from Medicare a más tardar el día del alta. Para SNF, salud en el hogar, CORF u hospicio, normalmente debe llamar al BFCC-QIO antes del mediodía del día anterior a la fecha de terminación del Notice of Medicare Non-Coverage.
Llame primero y reúna los documentos después. Pida que el profesional explique qué atención especializada todavía es necesaria. La falta de mejoría, por sí sola, no elimina la posible cobertura de atención especializada de mantenimiento.
Si pierde, lea la decisión de inmediato: la siguiente revisión rápida puede vencer al mediodía del día calendario siguiente. SHIP: 1-877-839-2675. Medicare: 1-800-633-4227.
Frequently Asked Questions
What is a Medicare fast appeal?
A Medicare fast appeal is an urgent independent review when a hospital discharge or the end of certain Medicare-covered SNF, home health, CORF, or hospice services may be happening too soon. The BFCC-QIO reviews the case.
What is the hospital fast-appeal deadline?
Follow the Important Message from Medicare no later than the day you are scheduled to be discharged. Calling earlier is safer because the appeal clock is short and the reviewer may need records.
What is the NOMNC fast-appeal deadline?
For SNF, home health, CORF, or hospice service termination, follow the Notice of Medicare Non-Coverage no later than noon the day before the termination date listed on the notice.
Can Medicare stop skilled care because I am not improving?
Not for that reason alone. If all other coverage rules are met, Medicare may cover skilled nursing or therapy needed to maintain your condition or to prevent or slow decline. The key question is whether skilled care is still required.
What if I missed the first fast-appeal deadline?
Call anyway. Medicare says other review options may still exist, but different timeframes and payment rules can apply. Hospital patients should contact the BFCC-QIO; Medicare Advantage members may also need to contact their plan.
What if the first fast appeal is denied?
Read the decision immediately and ask for the exact next expedited-review deadline. In fast-review tracks, a timely reconsideration can be due by noon of the calendar day after you receive the initial decision.
Can an adult child or caregiver help?
Yes. A family member or caregiver can help call, take notes, and gather records. If Medicare, the plan, or reviewer requires formal representation, use the Appointment of Representative process.
About This Guide
This guide uses official federal, state, local, and other high-trust nonprofit and community sources mentioned in the article.
Editorial note
This guide is produced based on our Editorial Standards using official and other high-trust sources, regularly updated and monitored, but not affiliated with any government agency and not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
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This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, and availability can change. Readers should confirm current details directly with the official program before acting.
Last updated: 26 September 2026 · Next review: 26 January 2027
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