How to Appeal a Hospital Discharge in Nevada

You have been told your parent is being discharged, and you believe the discharge is premature. The appeal window is short — roughly 24 hours — and the process is unforgiving if you miss the deadline. Here is exactly how to file.

The Timeline You Are Working With

When the hospital decides to discharge your parent, they must provide a written notice called the Detailed Notice of Discharge (Form CMS-10066), which explains their clinical reasoning. This triggers the clock:

• Deadline to file: You must contact the Quality Improvement Organization (QIO) by noon on the calendar day after you receive the discharge notice
• Who to call: For Nevada, the designated BFCC-QIO is Commence Health at 877-588-1123
• What to say: State that you are requesting an expedited review of a hospital discharge decision because you believe the patient is not safe to leave

This phone call — not a letter, not an email — initiates the appeal.

What Happens After You File

Once the appeal is filed:

1. The discharge is frozen. The hospital cannot move your parent out while the review is pending.
2. No billing during review. Your parent will not be charged for the continued hospital stay during the appeal period.
3. Clinical review begins. Commence Health obtains the medical record, the discharge plan, and the hospital's clinical justification. They may contact you for your perspective on why the discharge is unsafe.
4. Decision within 24-72 hours. The QIO must issue its determination promptly — most expedited reviews conclude within one to two business days.

If the QIO Rules Against You

A QIO determination in the hospital's favor is not the end. You have the right to escalate:

• Fast reconsideration by a Qualified Independent Contractor (QIC) — must be requested within 180 days
• Administrative Law Judge (ALJ) hearing — if the amount in controversy meets the 2026 threshold of $190
• Medicare Appeals Council — further administrative review
• Federal District Court — final judicial review

In practice, most families resolve the issue at the QIO or QIC level. The escalation steps exist as a safety net, but the initial appeal is where you buy the most critical time.

What If You Miss the Expedited Deadline

If you do not contact Commence Health by noon the day after receiving the discharge notice, you lose the right to an expedited review with billing protection. However, you can still request a standard QIO review at any time. The difference: during a standard review, the hospital can proceed with discharge and the patient may be billed for continued stay if they remain.

This is why the noon deadline matters. Missing it does not eliminate your appeal rights — it eliminates the financial and physical protection during the review.

What to Include in Your Appeal

When you call Commence Health, be prepared to explain:

• Why the discharge is unsafe — specific functional deficits (cannot walk, cannot manage medications, fall risk without supervision)
• What is missing from the discharge plan — no home health referral, no DME ordered, no caregiver training completed under Nevada's CARE Act
• The patient's current condition — level of pain, mobility, cognitive status, need for assistance with activities of daily living

You do not need a lawyer to file. The appeal is designed for patients and family members to use directly.

The IADA Alternative for Non-Medical Disputes

Not every discharge dispute is about medical necessity. If the problem is logistical — the hospital has not ordered durable medical equipment, the discharge instructions are incomplete, or the CARE Act training has not been provided — you can request Immediate Advocacy Discharge Assistance (IADA) through Commence Health. IADA is informal mediation that resolves procedural gaps without a formal clinical review.

The complete appeal process, including letter templates and a pre-filled contact directory for Nevada's QIO and ADRC offices, is covered in the Hospital-to-Home Nevada Toolkit.

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