Medicare Discharge Appeal Through Acentra Health QIO in Massachusetts

The skilled nursing facility just handed your mother a Notice of Medicare Non-Coverage. They say Medicare will stop paying for her rehabilitation in two days. She still cannot walk to the bathroom unassisted. You have until noon tomorrow to act.

Medicare discharge appeals in Massachusetts are handled by Acentra Health, the state's designated Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO). The process is fast, free, and — if you know the deadlines — remarkably effective.

Two Types of Discharge Appeals

Hospital Discharge Appeals

When a hospital plans to discharge your parent, they must deliver "An Important Message from Medicare" (IM) upon admission and a second copy within two days of the planned discharge date.

If you believe the discharge is premature, contact Acentra Health before midnight on the scheduled discharge day. The moment you file, the discharge freezes — the hospital cannot send your parent home or charge them during the review.

The hospital then has to provide a "Detailed Notice of Discharge" explaining the clinical rationale. You can submit a written rebuttal or a supporting letter from your parent's community physician. Acentra Health must issue a binding decision within 24 hours of receiving the complete file.

Skilled Nursing and Rehab Discharge Appeals (NOMNC)

When a SNF, home health agency, or rehab facility plans to end Medicare-covered services, they must deliver a Notice of Medicare Non-Coverage (NOMNC) at least two days before services are set to end.

You must contact Acentra Health by noon on the calendar day before the listed termination date. This is the most commonly missed deadline — families who wait until the termination date itself have already lost their window.

Once filed, the provider delivers a "Detailed Explanation of Non-Coverage." Acentra Health reviews the records, consults with the family and treating physician, and issues its decision within 72 hours.

Challenging a "Plateau" Determination

The most common trigger for a NOMNC is the facility claiming your parent has "plateaued" — meaning they are no longer making sufficient clinical progress to justify skilled care. This determination is often made around day 20–30, just as Medicare coinsurance kicks in.

Medicare's standard does not require steady improvement. Under the Jimmo v. Sebelius settlement, skilled care is covered when it is necessary to maintain the patient's current condition or prevent decline — even if recovery has stalled. A facility that says "your parent isn't improving, so Medicare stops" may be applying the wrong standard.

Document your parent's ongoing skilled care needs: daily wound care, physical therapy for safe transfers, medication management requiring nursing oversight. This documentation goes directly into your written response to Acentra Health.

If Acentra Health Denies Your Appeal

You can request an Expedited Reconsideration from the Qualified Independent Contractor — C2C Innovative Solutions, Inc. (Part A East) — by telephone or fax. This second-level appeal must be filed by noon on the calendar day following the QIO denial.

Under QIC rules, you can request a 14-day administrative extension to gather clinical letters, therapy notes, or a supporting physician statement. This extension is especially valuable when the initial appeal was filed under time pressure and the documentation was thin.

Contact Information

Acentra Health (BFCC-QIO for Massachusetts): 1-888-319-8452

C2C Innovative Solutions (QIC): Contact information is included in the QIO denial letter.

Get the Complete Appeal Timeline and Scripts

The Massachusetts Hospital-to-Home Transition Toolkit includes word-for-word appeal scripts for both hospital and SNF discharges, the NOMNC response template, and a visual calendar showing every deadline from the first notice through the QIC escalation.

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