Unsafe Hospital Discharge Appeal Michigan

The Hospital Wants to Discharge Your Parent — and You Think It's Unsafe

You have the right to stop it. If a Michigan hospital is pushing a discharge that would put your parent at clinical risk — no safe place to go, still unstable, caregiver not prepared — federal Medicare regulations give you an expedited appeal process that freezes the discharge while an independent reviewer evaluates whether it's appropriate.

The appeal goes through Commence Health, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) that handles Michigan. Here is exactly how the process works, with the deadlines that matter.

Before You Can Appeal: The Important Message from Medicare

The hospital must deliver Form CMS-10065 — "An Important Message from Medicare" — within two days of your parent's admission, and a second signed copy up to two days before the planned discharge. This form tells you:

• That your parent has the right to receive all hospital services they need
• That the discharge can be appealed through the BFCC-QIO
• The phone number and contact information for Commence Health

If you never received this form, ask for it immediately. The hospital is legally required to provide it, and it is your roadmap to the appeal.

How to File the Expedited Appeal

Deadline: You must contact Commence Health before midnight on the scheduled discharge day. If you miss this deadline, you lose the protective stay — meaning the hospital can proceed with discharge and begin charging your parent for continued hospitalization.

By phone: Call Commence Health at 1-888-524-9900. This is the fastest method. Have your parent's Medicare Beneficiary Identifier (MBI), date of birth, the hospital name, and the name of the attending physician ready.

Online: Commence Health operates an online appeal portal. The system has a strict 15-minute inactivity timeout — if you step away, you may need to start over. The appeal is only officially filed when you receive a confirmation page with a unique Case ID. Print or screenshot that confirmation.

What Happens After You File

Once Commence Health receives your appeal, two things happen immediately:

1. The hospital cannot discharge your parent. Medicare coverage continues during the review, and the hospital cannot bill your parent for the continued stay.
2. The hospital must deliver a Detailed Notice of Discharge (DND) — Form CMS-10066 — to both you and Commence Health by noon the following day. The DND must explain the clinical reasoning behind the discharge decision.

The hospital must also transmit your parent's complete medical record to Commence Health by the same noon deadline. Follow the submission instructions provided with the appeal notice.

The Review and Decision

Commence Health reviews the clinical documentation and issues a binding determination within one business day of receiving the hospital's records. There are two outcomes:

If Commence sides with you: Medicare coverage continues, and the hospital must follow the QIO determination. This does not guarantee an indefinite stay or require agreement from every family member.

If Commence sides with the hospital: Your parent becomes financially responsible for hospital charges starting the day after the decision. At that point, follow the notice instructions for any further Medicare appeal.

When to File — Practical Judgment Calls

Not every unwanted discharge warrants an appeal. The strongest cases involve:

• A parent who still cannot transfer from bed to wheelchair without physical assistance and has no trained caregiver at home
• DME (hospital bed, oxygen, wound care supplies) that has not been delivered to the home
• A medication regimen that requires skilled nursing supervision the family cannot provide
• An active infection or unstable vital signs that the attending physician has not resolved

Weaker cases — where the parent is clinically stable but the family simply wants more time to arrange post-discharge logistics — are less likely to succeed. Commence's review is focused on whether Medicare-covered care should end, not on solving a purely logistical delay.

Beyond the Appeal

If the appeal buys your family time, use it to arrange a safe landing. Contact your local Area Agency on Aging to start a MI Choice Waiver assessment, line up home health services, or evaluate skilled nursing facilities using CMS Care Compare ratings.

The Hospital-to-Home in Michigan guide includes the complete appeal workflow — timelines, forms, scripts for what to say when you call Commence Health, and a checklist for the 72-hour window after your parent comes home.

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