Commence Health Appeal Michigan

The Organization That Reviews Your Parent's Discharge Appeal

When a Michigan hospital or skilled nursing facility tries to end Medicare-covered care before your parent is ready, the appeal does not go back to the hospital. It goes to an independent federal contractor called the Beneficiary and Family Centered Care Quality Improvement Organization — the BFCC-QIO.

For Region 5 (which includes Michigan, Indiana, Illinois, Minnesota, Ohio, and Wisconsin), the BFCC-QIO is Commence Health. Commence Health operates the helpline, online portal, and clinical review for this region. Acentra Health is a separate BFCC-QIO serving other CMS regions, so use the contractor named on the notice you receive.

How to File the Appeal

You have two options:

Phone (fastest): Call Commence Health at 1-888-524-9900 (TTY: 1-888-985-8775). Lines are staffed Monday through Friday, but the midnight filing deadline applies every day including weekends. Have the following ready:

• Patient's Medicare Beneficiary Identifier (MBI)
• Patient's date of birth
• Hospital or facility name and the attending physician's name
• The specific reason you believe the discharge is unsafe

Online portal: Commence Health operates a web-based appeal submission system. Before you start, know that the system has a strict 15-minute inactivity timeout — if you pause to look something up, you may lose your progress and need to start over. You will need the same patient information listed above.

The appeal is only officially registered when you see a confirmation page with a unique Case ID. Screenshot or print this page. Without the Case ID, you have no proof the appeal was filed, and the hospital has no obligation to delay the discharge.

The Filing Deadline

You must contact Commence Health before midnight on the scheduled discharge day. Miss this deadline, and you lose the protective stay — the hospital can proceed with discharge, and Medicare coverage for continued hospitalization stops.

If the hospital tells you at 4 p.m. that your parent is being discharged tomorrow morning, you have until midnight tonight to file. Do not wait until the morning. Call immediately.

What Happens After You File

Once the appeal is registered:

1. The discharge is frozen. The hospital cannot send your parent home, and Medicare continues to pay for the stay during the review period.

2. The hospital must produce a Detailed Notice of Discharge (DND) — Form CMS-10066 — by noon the day after you file. This document must state the clinical reasons the hospital believes the discharge is appropriate.

3. The hospital must transmit the complete medical record to Commence Health by the same noon deadline.

4. Commence Health reviews the case and issues a binding determination within one business day of receiving the medical records.

The Two Possible Outcomes

Appeal granted (Commence sides with you): Medicare coverage continues, and the hospital must follow the QIO determination. This does not guarantee an indefinite stay or require agreement from every family member.

Appeal denied (Commence sides with the hospital): Your parent becomes financially responsible for hospital charges beginning the day after the decision. At that point, follow the notice instructions for any further Medicare appeal.

Beyond the Expedited Appeal: Immediate Advocacy

Commence Health also offers Immediate Advocacy Discharge Assistance (IADA) for Original Medicare beneficiaries. This is a less formal process — a Commence Health representative contacts the hospital directly to try to resolve discharge concerns without a formal appeal.

IADA works best when the issue is logistical (DME not delivered, home health referral incomplete, caregiver instruction not provided) rather than a fundamental disagreement about clinical readiness. If IADA does not resolve the issue, you can still file a formal expedited appeal.

Other Appeal Triggers

Commence Health handles more than hospital discharge appeals. You can also file through them when:

• A skilled nursing facility issues a Notice of Medicare Non-Coverage (NOMNC) ending rehab services
• Home health or hospice services are being terminated
• A patient's hospital status is reclassified from inpatient to observation (the Medicare Change of Status Notice appeal, available since February 2025)

The Hospital-to-Home in Michigan guide includes the full appeal workflow with scripts, timelines, and a decision tree for when to use IADA versus a formal expedited appeal.

See more Michigan guides →