Medicare Discharge Appeal Missouri: Commence Health QIO Process

Missouri's Medicare Appeal Contractor: Commence Health

When a patient with Original Medicare in Missouri disagrees with a hospital discharge decision, the appeal goes through Commence Health — the federally designated Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for CMS Region 7, which covers Missouri, Iowa, Kansas, and Nebraska.

Families often encounter outdated references to previous contractors like Kepro or Acentra Health. As of 2026, Commence Health is the current BFCC-QIO contractor for Missouri's hospital and skilled-care discharge appeals; Kepro and Acentra Health are older contractor names.

Commence Health Contact Information:

• Phone: 1-888-755-5580
• Hours vary; 24-hour voicemail, case-status updates, and online appeal services are available
• TTY: 711
• Fax: 1-855-694-2929

How the Appeal Process Works for Original Medicare

For patients with Original Medicare (Parts A and B, not a Medicare Advantage plan), the appeal follows a specific sequence:

Before discharge: The hospital must deliver "An Important Message from Medicare" (Form CMS-10065) explaining the patient's right to appeal. The family or patient contacts Commence Health by noon on the planned-discharge day and before the planned discharge time if that time is earlier.

During review: Once the appeal is filed, the discharge is legally stayed. The hospital cannot send the patient home and cannot bill for additional days during the review period. Commence Health assigns an independent physician reviewer who examines the hospital's medical records.

After review: Commence Health issues a written determination. If the reviewer agrees with the family, the hospital must revise its discharge plan. If the reviewer agrees with the hospital, the patient becomes financially responsible for hospital charges starting at noon on the day after the determination is delivered.

The entire fast-track review typically takes 24 to 48 hours.

Medicare Advantage Expedited Appeals

Medicare Advantage plan members follow a different path for coverage denials. The family must first request an expedited appeal from their Medicare Advantage plan, which is required to issue a decision within 72 hours. If a qualifying service-termination notice is issued, follow the notice's instructions for a direct BFCC-QIO fast-track review.

If the Medicare Advantage plan upholds a coverage denial and the family disagrees, the case can then be escalated to the applicable independent review process. This makes it critical to start the appeal process as early as possible.

Key difference: with Original Medicare, one call to Commence Health can immediately pause a qualifying discharge. With Medicare Advantage, start with the plan's internal expedited appeal for a coverage denial; a qualifying NOMNC or hospital discharge notice may also support a direct QIO fast-track appeal.

Common Mistakes That Weaken an Appeal

Waiting until discharge day. The appeal must be filed by noon on the planned-discharge day and before the planned discharge time if that time is earlier. Families who wait until the morning of discharge risk missing the window. If the Important Message from Medicare lists a discharge date, call Commence Health the day before.

Not documenting the clinical situation. When you call Commence Health, clearly describe why you believe the discharge is premature. Specific clinical details matter — "my mother cannot walk to the bathroom unassisted and no home health aide has been arranged" is far stronger than "we don't think she's ready."

Confusing observation status with inpatient admission. A standard QIO fast-track discharge appeal generally concerns an inpatient discharge. If the hospital changed your parent from inpatient to observation while they are still hospitalized, ask about a Medicare Change of Status Notice (CMS-10868) and the prospective appeal route under Alexander v. Azar.

What to Do After a Successful Appeal

A successful appeal buys time, but it does not solve the underlying discharge planning problem. Use the extended stay to:

• Coordinate home health services or skilled nursing facility placement
• Ensure durable medical equipment is ordered and delivery confirmed
• Complete a medication reconciliation with the hospital pharmacist
• Schedule a follow-up appointment with the parent's primary care physician within 7 to 14 days

The Missouri Hospital Discharge Guide provides the complete appeal timeline, word-for-word scripts for calling Commence Health, and a discharge readiness checklist that documents whether each element of a safe care plan is in place.

See more Missouri guides →