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Requesting a Fast Medicare Appeal Before Services End

Adapted from Medicare Appeals, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Your right to a fast appeal

You have the right to a fast appeal

You have the right to a fast appeal in some situations.

If you’re a hospital inpatient and the hospital decides that your inpatient stay is ending, they’ll give you a written notice called “An Important Message from Medicare about Your Rights” (sometimes called the “Important Message from Medicare” or the “IM”). You’ll get this notice before your services end, and it will tell you how to ask for a fast appeal. If they don’t give you this notice, ask for it. This notice lists the Beneficiary and Family Centered Care Quality Improvement Organization (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

You may have the right to ask for a fast appeal if you think your services from one of these providers are ending too soon:

  • Hospital
  • Skilled nursing facility (SNF)
  • Home health agency (HHA)
  • Comprehensive outpatient rehabilitation facility (CORF)
  • Hospices

Your provider will give you a Notice of Medicare Non-Coverage (NOMNC) 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, called a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), will decide if your covered services should continue.

What do I need to know before I ask for a fast appeal?

In a hospital: Within 2 days of your admission and before 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.

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 give you a new one (that you must sign) before you’re discharged.

In other settings: You should get a notice called “Notice of Medicare Non-Coverage” at least 2 days before covered services end. If you don’t get this notice, ask for it.

In hospitals or other settings the notice you get will include:

  • Your right to appeal and the steps for appealing.
  • The circumstances under which you will or won’t have to pay for services you get after the coverage end date on your notice.
  • The date your covered services will end.
  • Information on your right to get a detailed notice about why your covered services are ending.
  • Your right to a fast appeal and information on how to contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in your state. The BFCC-QIO is administered for Medicare by Livanta or Acentra, depending on what state you live in. Check Commencehealthqio.cms.gov/ or Acentraqio.com/ to make sure you’re contacting the right organization for your state.

How do I ask for a fast appeal?

In a hospital: Follow the directions on the “Important Message from Medicare” 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 Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) 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.

In other settings: Follow the instructions on the “Notice of Medicare Non-Coverage” no later than noon the day before the termination date listed on the notice.

If you miss the deadline to ask for a fast appeal from the BFCC-QIO, you can ask for a fast reconsideration from your plan, but services will only be covered if there’s a decision issued in your favor.

What will happen during the BFCC-QIO’s review?

In a hospital: The BFCC-QIO will notify the hospital. If you have a Medicare health plan, the BFCC-QIO will notify your plan and the hospital. Then, by noon the day after the BFCC-QIO notifies the hospital (or your plan), the hospital will give you a “Detailed Notice of Discharge.”

In other settings: The BFCC-QIO will notify the provider. Then, by the end of the day that the provider gets the notice from the BFCC-QIO, the provider will give you a “Detailed Explanation of Non-Coverage.”

In hospitals or other settings the notice you get will include:

  • Why your services are no longer reasonable and necessary or are no longer covered
  • A description of the applicable Medicare coverage rule or policy, including information on how you can get a copy of the policy
  • How the applicable coverage rule or policy applies to your specific situation

You can also ask for copies of any of the materials that were sent to the BFCC-QIO.

In all cases, the BFCC-QIO will:

  • Ask why you believe coverage for the services should continue
  • Look at your medical records and the information provided by the hospital, provider or your plan
  • Make a decision:
  • In a hospital: Within one day of getting the requested information
  • In other settings: By close of business the day after it gets the information it needs to make a decision

What does the BFCC-QIO decision mean for my appeal?

In a hospital:

  • If they decide your services are ending too soon: Medicare will continue to cover (except for applicable coinsurance or deductibles) your hospital stay as long as medically necessary. If you get any inpatient hospital services after noon of that day, you may have to pay for them.
  • If they decide your services should end: If you met the deadline for asking for a fast appeal, you won’t be responsible for paying the hospital charges (except for applicable coinsurance or deductibles) you have through noon of the day after the BFCC-QIO gives you its decision. If you get any impatient hospital services after noon that day, you may have to pay for them.

In other settings:

  • If they decide your services are ending too soon: Depending on your care needs, Medicare may continue to cover your skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice services (except for applicable coinsurance or deductibles).
  • If they decide your services should end: You won’t be responsible for paying for any skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice services provided before the coverage end date on the “Notice of Medicare Non-Coverage.” If you continue to get services after the coverage end date, you may have to pay for those services.

If you have any questions about fast appeals, call the BFCC-QIO at the phone number listed on the notice you get from the facility. You can also visit CMS.gov/ medicare/quality/quality-improvement-organizations/family-centered-care or call 1-800-MEDICARE (1-800-633-4227) to get the BFCC-QIO’s phone number. TTY users can call 1-877-486-2048.

Appeal when a hospital changes your status from “inpatient” to “outpatient getting observation services”

You have the right to ask for a fast appeal if you were admitted as a hospital inpatient, and your status was changed to “outpatient getting observation services” during your hospital visit. Your hospital status affects what you pay, and if Medicare will cover skilled nursing care after you leave the hospital.

If your status is changed from “inpatient” to “outpatient getting observation services” during your hospital stay, you should get a “Medicare Change of Status Notice (CMS-10868)” before you leave the hospital. If you don’t get this notice, ask for it. This notice explains:

  • Your hospital stay will be billed to Medicare Part B instead of Part A. Depending on the Part B coinsurance you owe as an outpatient, your hospital bill may be lower or higher than the Part A inpatient deductible.
  • Your stay will be billed as an outpatient if you don’t have Medicare Part B. This means the hospital will charge you the full cost of your outpatient hospital stay.
  • Medicare won’t pay if you go to a skilled nursing facility after you leave the hospital.
  • Your right to a fast appeal and information on how to contact your state BFCC-QIO to ask for a fast appeal. The BFCC-QIO is administered for Medicare by Commence Health or Acentra, depending on what state you live in. Check their websites to make sure you’re contacting the right organization for your state.
  • If you have questions about billing, ask your hospital for more information.

What happens after I file an appeal?

When the BFCC-QIO gets your appeal, the BFCC-QIO will:

  • Let the hospital know that you filed an appeal.
  • Ask the hospital for your medical records and any relevant information.
  • Give the hospital a chance to explain why the change in status from an inpatient to an outpatient getting observation services is appropriate.
  • Look at your medical records and the information provided by the hospital.
  • Make a decision and let you know what they decided about 2 days after you file your appeal.

You can ask for copies of any of the materials that were sent to the BFCC-QIO.

What happens when my appeal is decided?

The BFCC-QIO will notify you and the hospital once your appeal is decided.

  • If they decide that your status shouldn’t have changed: You’ll be responsible for paying the Medicare Part A inpatient hospital deductible. You may qualify for a Medicare-covered skilled nursing facility stay within 30 days of your discharge from this hospital stay (if other coverage requirements are also met).
  • If they decide that your status should have changed: You’ll be responsible for paying the Medicare Part B costs (if you have Medicare Part B). If you don’t have Medicare Part B, you may be responsible for the full cost of your outpatient hospital stay. You won’t qualify for a Medicare-covered skilled nursing facility stay after you leave the hospital.

Source and further reading

Medicare Appeals — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.

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