How to File a Fast Medicare Appeal of Your Hospital's Discharge Order

If you think your Medicare-covered stay in a hospital is ending too soon, you have the right to request an expedited, or "fast," appeal if you disagree with this decision.

The Basics of a Fast Appeal

Beneficiaries who receive services under Medicare Part A for a hospital stay may request an expedited review, also known as a "fast appeal," if the hospital decides to terminate your services or discharge you too soon. While there are five total levels of appeal, only the first two levels can be done on an "expedited" basis.

It is important to follow the correct procedure for a fast appeal of a discharge from a hospital, which is different from the procedures for requesting a fast appeal in a non-hospital setting, such as a skilled nursing facility (SNF), home health agency (HHA), comprehensive outpatient rehabilitation facility (CORF), or hospice services.

How to Request an Expedited Appeal From a Hospital Discharge

If you disagree with your hospital's decision to discharge you, you have the right to request an expedited review by the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for your area. While you can't be discharged while the BFCC-QIO's decision is pending, you can still be responsible for any applicable coinsurance or deductibles.

Your appeal rights are found in a notice called "An Important Message from Medicare about Your Rights," also called the "IM." You should have received a copy of the IM within two days of your hospital admission and should have been asked to sign it. Ask for the IM if you didn't get it.

The hospital must also give you a copy of the IM you signed within two (2) days of your scheduled discharge date. It is very important to follow the directions found in the IM; otherwise, your financial responsibility and appeal rights may be negatively affected.

Level 1 Fast Appeal

Your first level of appeal is to the BFCC-QIO for the area in which you received Medicare services. You will find the name and phone number of the BFCC-QIO for your area in your IM.

Note that you must ask for a fast appeal no later than the day you're scheduled to be discharged from the hospital. If you miss this deadline, you may still request an expedited review, but different financial responsibility rules and time frames will apply. (As long as you request the review on time, you can't be held liable for the full cost of your care until the decision is made.)

Level 2 Fast Appeal

If the BFCC-QIO disagrees with the hospital's decision to discharge you, you can stay in the hospital under a Medicare-covered stay.

If, however, the BFCC-QIO agrees with the hospital's decision to discharge you, you have two options. By noon of the day after you receive the QIO's decision, you must decide whether to leave the hospital, or stay and appeal the decision to a Qualified Independent Contractor (QIC). This is your second level of a fast appeal, also known as a "Request for Reconsideration."

If you decide to stay, you may be financially responsible for the full cost of care you receive at the hospital starting as of noon of the day you received the BFCC-QIO's decision. You can also stay in the hospital if you agree to pay all of the costs yourself.

If the QIC agrees with the hospital's decision to discharge you, you may still pursue three further levels of appeal for Medicare coverage and reimbursement of your costs for this stay.

Further Levels of Appeal

If you receive an unfavorable QIC reconsideration decision that says Medicare will not cover or pay for your continued stay in the hospital, you have three remaining levels of appeal: a Level 3 hearing with an administrative law judge; a Level 4 request for review from the Medicare Appeals Council (MAC); and finally, filing a lawsuit in United States District Court. Each of these levels has different timelines and minimum required amounts in dispute. The QIC's decision will contain instructions for requesting a hearing from an administrative law judge. (For a description of these last three levels of appeal, read our article on regular appeals of Medicare Part A.)

Where to Get Additional Information

For more information on Medicare's expedited appeals process, go to the Medicare website's fast appeals area. If you need help filing your appeal, you can contact:

• your State Health Insurance Assistance Programs (SHIP)
• the Center for Medicare Advocacy, or
• a Medicare lawyer.