How to Appeal a Hospital Discharge Under Medicare: The QIO Fast-Appeal Process

The case manager just told you your parent is being discharged tomorrow. Your parent cannot walk to the bathroom without help, there is no one at home trained in wound care, and the home safety equipment has not arrived. You know this is not safe.

You have the legal right to stop it. Here is exactly how Medicare's fast-appeal process works, the deadlines you cannot miss, and the words to say on the phone.

Your Parent's Right to Appeal

Every Medicare beneficiary has the right to appeal a hospital discharge. When the hospital issues a discharge notice, it must provide two documents:

"An Important Message from Medicare" (IM notice): Given at admission and again at discharge. This document lists the phone number for the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) that handles appeals in your state.

"Detailed Notice of Discharge" (DND): Provided within two days of the discharge date. It explains why the hospital believes continued inpatient care is no longer necessary.

If you did not receive these documents, ask the charge nurse or patient advocate immediately. The hospital is legally required to provide them.

The Fast-Appeal Timeline

This is a same-day process. Timing is everything:

File before midnight on the planned discharge day. Call the BFCC-QIO listed on your IM notice. Currently, two organizations handle all Medicare discharge appeals nationally:

• Livanta/Commence Health — covers most states
• Acentra Health — covers remaining states

You can find which organization covers your state by calling 1-800-MEDICARE (1-800-633-4227).

What happens when you file:

1. The hospital must provide your parent's medical records to the QIO within 24 hours
2. A physician reviewer at the QIO evaluates whether the discharge is medically appropriate
3. The QIO issues a decision, typically within 24 to 48 hours
4. While the appeal is pending, your parent stays in the hospital at no additional cost. Medicare continues to pay through at least noon on the day after the QIO decision is issued

This is the critical point families miss: filing the appeal before the deadline freezes the discharge and keeps your parent covered. There is no financial risk to filing.

What to Say on the Phone

Call the QIO and say:

"I am calling to file an expedited appeal of a hospital discharge under Medicare. My parent's name is [name], their Medicare Beneficiary Identifier is [MBI number], and the hospital is [hospital name]. The discharge is planned for [date]. I believe this discharge is unsafe because [specific clinical reasons]."

Specific clinical reasons that strengthen an appeal:

• No trained caregiver available at home to provide required care
• Home safety equipment (hospital bed, wheelchair ramp, grab bars) has not been delivered
• Wound care requires skilled nursing that home health has not yet been set up to provide
• Cognitive changes (delirium, confusion) make the patient unable to safely manage at home
• Fall risk is high and the home has not been modified
• Follow-up appointments have not been scheduled and critical medication changes have not been reconciled

You do not need a lawyer. You do not need medical training. Anyone acting in good faith on behalf of the patient can file.

If the Appeal Is Denied

If the QIO upholds the discharge, your parent must leave the hospital and becomes financially responsible for charges starting noon the day after the decision.

You can file a second-level appeal with a Qualified Independent Contractor (QIC) within 180 days. This is a longer process and does not freeze the discharge, but it can result in retroactive Medicare coverage if the decision is reversed.

More immediately, use the additional 24 to 48 hours the appeal bought you to:

• Get home health services in place (call the agency directly, do not wait for the hospital coordinator)
• Confirm durable medical equipment delivery
• Complete essential home safety modifications
• Schedule the 7-day primary care follow-up
• Set up the medication system

Skilled Nursing Facility Discharges Work Differently

If your parent is being discharged from a skilled nursing facility (SNF) or home health agency rather than a hospital, the timeline is different:

File by noon on the day before services are scheduled to end. The hospital deadline is midnight; the SNF/home health deadline is noon the day before. The document you need is the "Notice of Medicare Non-Coverage" (NOMNC), not the IM notice.

The review process and cost protections are the same: the QIO evaluates, your parent stays covered during the review, and there is no fee to file.

The Rehab and Recovery at Home Toolkit includes the complete discharge appeal process with word-for-word scripts, QIO contact information, and a pre-discharge safety checklist to ensure your parent's home is ready before they leave the hospital.