How to Appeal a Hospital Discharge in New Hampshire

The Deadline That Matters Most

You must contact Acentra Health before your parent leaves the hospital and before midnight on the day the hospital has scheduled your parent's discharge. Not the next morning. Not during business hours. Before midnight that same day. If you miss this window, the hospital can proceed with the discharge and you lose the automatic stay that keeps your parent in their bed while an independent medical review takes place.

Acentra Health is New Hampshire's designated Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). They handle Medicare discharge appeals for all of Region 1, which includes New Hampshire. The toll-free number is 1-888-319-8452.

Step-by-Step: Filing the Appeal

Before calling Acentra Health, make sure you or your parent have received the "Important Message from Medicare" (Form CMS-10065). The hospital is required to deliver this form within two days of admission and, when a follow-up copy is required, deliver the signed copy no more than two calendar days before the planned discharge. This form explains your appeal rights.

Here's the sequence:

1. Call Acentra Health at 1-888-319-8452 and state that you want to appeal a hospital discharge. You can call on behalf of your parent if you have a healthcare power of attorney or are their designated representative.

2. The hospital must then deliver a Detailed Notice of Discharge (Form CMS-10066) by noon the next day. This document outlines the specific clinical reasons the hospital believes your parent no longer needs acute care.

3. Acentra Health reviews the complete clinical record. Their independent physician reviewers evaluate whether the discharge is medically appropriate, typically within 24 hours of receiving all records from the hospital.

4. You receive a binding determination. If Acentra Health sides with you, the hospital must continue providing care under Medicare. If the appeal is denied, your parent becomes financially responsible for inpatient services after noon of the calendar day following the decision.

During the entire review period, the hospital cannot discharge your parent and cannot bill them for continued care. That's the legal protection that makes filing the appeal worth the phone call, even if you're uncertain about the outcome.

Post-Acute Service Termination Appeals

The appeal process works differently when a skilled nursing facility, home health agency, or hospice provider tries to end covered services. In these situations, the provider must issue a Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123) at least two calendar days before the proposed service termination.

The deadline for this appeal is stricter: you must contact Acentra Health before noon on the day before services are scheduled to end. Not midnight — noon.

For patients on original Medicare (Fee-for-Service), this is called a BIPA review. For Medicare Advantage enrollees, it's a Grijalva review. The critical difference: if your parent has Medicare Advantage and you miss the noon deadline, Acentra Health cannot review the case at all. The appeal gets routed through the managed care company instead, which lacks the same independent review protections.

One legal standard works in your favor here. Under the Jimmo v. Sebelius settlement, Medicare covers skilled care required to maintain a patient's current condition or prevent slow deterioration when the other coverage requirements are met. A provider cannot lawfully terminate services solely because your parent has "plateaued" or isn't showing active improvement; the clinical record must still support the need for skilled care.

What to Prepare Before You Call

Gather these before picking up the phone:

• Your parent's full name, date of birth, and Medicare number
• The hospital name, unit, and attending physician's name
• Your relationship to the patient and any legal authority documentation (healthcare POA, guardianship order)
• A brief written summary of why you believe the discharge is unsafe — specific symptoms, functional limitations, or unresolved medical issues

You don't need a lawyer to file a discharge appeal. The process is designed for families to use directly, and there is no cost to file. The New Hampshire Hospital Discharge Guide includes an appeal worksheet with pre-formatted language that maps to the criteria Acentra Health reviewers actually evaluate.

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