Acentra Health Maine: How to File a Hospital Discharge Appeal

Acentra Health (formerly Kepro) is the federally designated Quality Improvement Organization for Medicare beneficiaries in Maine. If your parent is being discharged from a Maine hospital and you believe it's too soon, Acentra is the organization that can legally stop the discharge and review whether it's medically appropriate.

Most families have never heard of Acentra Health until a discharge planner hands them a form and says "you can call this number if you disagree." Here's what that process actually looks like.

When to Call Acentra Health

Call Acentra when you believe a hospital discharge is clinically premature — meaning your parent still needs acute care that can't be safely provided at home or in the proposed post-discharge setting.

You should also call Acentra when a home health agency, skilled nursing facility, or hospice provider is terminating services. In those cases, the provider must issue a Notice of Medicare Non-Coverage (NOMNC) at least two days before services stop. You can appeal the termination through Acentra before coverage actually ends.

Acentra Health contact: 1-888-319-8452 (available 24/7 for urgent discharge appeals)

The Appeal Process Step by Step

Step 1: Get the Important Message from Medicare. The hospital must deliver this notice at admission and again within two days of a planned discharge. It outlines your appeal rights and includes Acentra's contact information.

Step 2: Call Acentra before midnight on the planned discharge day. This is the critical deadline. Filing the appeal before leaving the hospital on the scheduled discharge date triggers an automatic stay — the hospital cannot discharge your parent or charge them for continued care while the review is pending.

Step 3: The hospital responds with a Detailed Notice of Discharge (DND). This document explains the clinical reasoning for the discharge. Read it carefully — it's the hospital's case for why your parent is ready to leave.

Step 4: Acentra's clinical panel reviews the medical record. A team of physicians and nurses evaluates whether the discharge meets clinical standards. They review the hospital's documentation and may contact the attending physician.

Step 5: Acentra issues a determination. If they find the discharge is premature, the patient stays and Medicare continues covering the hospitalization. If they uphold the discharge, you can request a reconsideration through the Qualified Independent Contractor (QIC) within 60 days.

Immediate Advocacy Discharge Assistance (IADA)

Acentra also offers a lesser-known service called Immediate Advocacy Discharge Assistance for Original Medicare patients. If the problem isn't that the discharge itself is wrong, but that communication has broken down between your family and the hospital's case management team, IADA provides a neutral mediator to resolve the dispute without a formal appeal.

This can be useful when the issue is about the discharge destination (you want rehab, the hospital is sending your parent home) rather than the timing.

What to Prepare Before Calling

When you call Acentra, have this information ready:

• Your parent's full name, date of birth, and Medicare number
• The hospital name and the attending physician's name
• The planned discharge date
• A clear statement of why you believe the discharge is unsafe (be specific — "they can't walk to the bathroom unassisted" is stronger than "they don't seem ready")
• Names of any medications changed during the hospitalization
• Whether durable medical equipment or home health services have been arranged

The Hospital-to-Home Maine toolkit includes pre-written appeal scripts and a QIO call preparation worksheet so you're not scrambling to organize this information in a hospital corridor.

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