Appeal Hospital Discharge Medicare Pennsylvania: Step-by-Step Process

Your parent's hospital just handed you a discharge notice. You think the discharge is premature. You have a narrow window to file an appeal — and if you miss it, the legal protections vanish.

Here is the exact process for appealing a hospital discharge through Medicare in Pennsylvania.

Step 1: Read the Important Message from Medicare

The hospital should have given your parent (or their legal representative) "An Important Message from Medicare" (Form CMS-10065) within two days of admission. A second copy is required before discharge. This form contains the phone number for the appeals organization and the discharge deadline.

If you never received this notice, tell the hospital in writing. The form is legally required. Its absence does not eliminate the appeal right, but having it documented matters.

Step 2: Call Commence Health Before the Deadline

Commence Health is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Region 3, which includes Pennsylvania. They replaced Livanta effective August 18, 2025 — many online resources still reference the old name.

Commence Health Region 3 helpline: 1-888-396-4646

Call by the discharge deadline listed in the Important Message to request an expedited appeal. Once you file:

• The hospital cannot discharge your parent while the review is pending.
• The hospital cannot charge your parent for care during the review period.
• The hospital must deliver a "Detailed Notice of Discharge" (Form CMS-10066) by noon the following day, explaining the clinical reasons for discharge.

Step 3: Present Your Case

When you call Commence Health, be specific about why the discharge is premature. Effective arguments focus on clinical facts:

• Unstable vital signs, ongoing fever, or unresolved infection
• Insufficient home care arrangements — no agency scheduled, no caregiver trained
• New medications with no plan for monitoring side effects
• Inability to perform basic activities independently (toileting, transfers, eating)
• No follow-up appointments scheduled with specialists

Write these concerns down before you call. Commence Health will also ask the hospital for the full medical record, so the clinical picture will be reviewed by an independent physician.

Step 4: Wait for the Decision

Commence Health issues its decision within 24 to 72 hours of receiving the medical records. You will receive both a verbal notification and a written decision.

If the appeal is upheld: Your parent stays in the hospital. The discharge was premature, and the facility must continue providing care under Medicare.

If the appeal is denied: You have two options. Your parent can leave as planned, or they can stay — but the financial protections end. The hospital can issue an Advance Beneficiary Notice (ABN) for custodial care and bill your parent directly for each additional day.

Step 5: Escalate if Needed

A denied appeal is not the end of the road. You can request a reconsideration through the Qualified Independent Contractor (QIC), which provides a second level of review. The written denial from Commence Health will include instructions for this next step.

You can also file a formal complaint with the Pennsylvania Department of Health (1-800-254-5164) if you believe the hospital's discharge planning was negligent — for example, if the facility failed to arrange necessary home health services or did not conduct a care conference with your family.

The SNF Discharge Appeal Process

The process for skilled nursing facilities is slightly different. When a SNF plans to end Medicare-covered services, it must issue a Notice of Medicare Non-Coverage (NOMNC) at least two calendar days before coverage ends. The same Commence Health number handles the appeal, and the same financial protections apply during the review.

SNF appeals matter most when the facility is ending rehabilitation services before day 100. Under the Jimmo v. Sebelius standard, Medicare must continue covering skilled nursing care as long as the patient needs skilled services to maintain function — not only when they are improving. If your parent's therapists say maintenance therapy is medically necessary, that is grounds for an appeal.

Timing Is Everything

The appeals process protects families, but only if you act within the window. Once the discharge happens without an appeal, the leverage shifts entirely — getting a patient readmitted is far harder than preventing a premature discharge.

The Pennsylvania Hospital Discharge Guide includes appeal timeline worksheets and documentation templates that keep you inside the deadline no matter how fast the hospital moves.

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