Getting a fast appeal in a hospital

If you’re getting Medicare services from a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice, and you think your Medicare‑covered services are ending too soon (or that you’re being discharged too soon), you can ask for a fast appeal. Your provider will give you a notice called a Notice of Medicare Non Coverage before your services end, telling you how to ask for a fast appeal. You should read this notice carefully. If you don’t get this notice, ask your provider for it. With a fast appeal, an independent reviewer will decide if your covered services should continue.

You can contact your Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) for help with filing an appeal. A fast appeal only covers the decision to end services. You may need to start a separate appeals process for any items or services you may have received after the decision to end services. For more information, view the booklet Medicare Appeals. 

You may be able to stay in the hospital ( 

coinsurance and  

deductible may apply) while the BFCC-QIO reviews your case. The hospital can’t force you to leave before the BFCC-QIO reaches a decision.

Within 2 days of your admission and prior to your discharge, you should get a notice called “An Important Message from Medicare about Your Rights.” This notice is sometimes called the Important Message from Medicare or the IM. If you don’t get this notice, ask for it. This notice lists the BFCC-QIO’s contact information and explains:

• Your right to get all medically necessary hospital services
• Your right to be involved in any decisions that the hospital, your doctor, or anyone else makes about your hospital services and to know who will pay for them
• Your right to get the services you need after you leave the hospital
• Your right to appeal a discharge decision and the steps for appealing the decision
• The circumstances under which you will or won’t have to pay for charges for continuing to stay in the hospital
• Information on your right to get a detailed notice about why your covered services are ending

If the hospital gives you the IM more than 2 days before your discharge day, it must give you a copy of your original, signed IM or provide you with a new one (that you must sign) before you’re discharged.

You may have the right to ask the BFCC-QIO for a fast appeal. Follow the directions on the IM to request a fast appeal if you think your Medicare-covered hospital services are ending too soon. You must ask for a fast appeal no later than the day you’re scheduled to be discharged from the hospital.

If you ask for your appeal within this time frame, you can stay in the hospital while you wait to get the BFCC-QIO’s decision. You won’t have to pay for your stay (except for applicable coinsurance or deductibles).

If you miss the deadline for a fast appeal, you can still ask the BFCC-QIO to review your case, but different rules and time frames apply and you might be responsible for the cost of the hospital stay past the original day the hospital tries to discharge you. If you’re in a Medicare Advantage Plan, you can ask your plan for an appeal, but different rules apply.