How to Appeal Hospital Discharge Medicare Ohio

The Medicare Discharge Appeal Process in Ohio

A Medicare hospital discharge appeal in Ohio goes through Commence Health, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) that covers Ohio as part of CMS Region 5. Commence Health is independent of the hospital — their physician reviewer evaluates whether the discharge is medically appropriate without pressure from the facility's length-of-stay targets.

Here's the process from start to finish.

Step 1: Get the Important Message from Medicare

The hospital must give your parent a document titled "An Important Message from Medicare" (IM notice) within two days of admission. This form outlines discharge rights and explains how to file an appeal. If the hospital provides the IM more than two days before discharge, it must provide a copy of the signed original or issue a new one for signature before the patient can be released.

When the discharge planner tells you the discharge date, confirm that you have a current copy of the IM notice. If you don't have one, request it in writing. The scheduled discharge day is the key deadline for the fast appeal.

Step 2: Call Commence Health Before Midnight

The appeal must be filed before midnight on the scheduled discharge day. Call Commence Health at 1-888-396-4646 (the Region 5 line for Ohio). You can also submit an appeal online.

When you call, state:

• The patient's name and Medicare number
• The hospital name and unit
• That you are requesting a fast appeal of a hospital discharge
• Your specific concerns about why the discharge is premature or unsafe

If someone other than the patient is filing the appeal, you may need to complete CMS Form 1696 to designate yourself as the patient's representative. The hospital's patient representative office can provide this form, or Commence Health can walk you through it on the phone.

Step 3: The Hospital Responds

Once Commence Health notifies the hospital of the appeal, the hospital must deliver a Detailed Notice of Discharge to the patient and to Commence Health by noon of the following day. This document lays out the hospital's clinical reasoning for why the patient is ready for discharge.

The hospital also transmits the relevant medical records. Commence Health's reviewer evaluates the full record, not just the hospital's summary.

Step 4: The Independent Review

An independent physician at Commence Health reviews:

• The patient's current clinical status
• The hospital's discharge plan and clinical reasoning
• Whether adequate post-acute care arrangements are in place
• Whether the patient can safely transition to the planned setting

The review typically takes 24 to 48 hours. During this entire period, the patient remains in the hospital under Medicare coverage with no additional financial liability beyond standard copays and deductibles.

Step 5: The Decision

If Commence Health sides with you: The hospital must revise the care plan and continue treatment. The discharge is halted. Medicare continues covering the stay.

If Commence Health sides with the hospital: Your parent can remain through noon of the day after the decision without additional charges. After that, continued hospital care becomes the patient's financial responsibility.

Beyond the First Appeal

A negative QIO decision isn't the end. You can request reconsideration through the Qualified Independent Contractor (QIC), which is the next level in Medicare's appeals chain. This review takes longer and does not extend the financial protection that the initial fast appeal provides.

In practice, most families use the fast appeal window to arrange the post-acute care that wasn't ready at the time of the original discharge notice — lining up home health agencies, coordinating PASSPORT waiver intake with the Area Agency on Aging, or securing a bed at a preferred skilled nursing facility.

Common Mistakes That Weaken an Appeal

Missing the midnight deadline. Once midnight passes on the scheduled discharge day, the fast appeal window closes. If the hospital delivers the notice late in the day, act immediately.

Being vague about concerns. "We don't think Dad is ready" is less effective than "Dad cannot walk to the bathroom unassisted, no home health agency has been arranged, and the prescribed wound care requires skilled nursing that no family member has been trained to provide."

Assuming verbal refusal is enough. Telling the nurse or discharge planner that you refuse to take your parent home is not a formal appeal. Only contacting Commence Health triggers the legal stay and financial protection.

The Ohio Hospital-to-Home Discharge Guide includes a pre-call preparation worksheet for the Commence Health appeal, a timeline tracker for every deadline, and scripts for communicating with the discharge planning team.

See more Ohio guides →