To appeal a hospital discharge under Medicare, call the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) listed on your discharge notice no later than the day you are scheduled to leave. Filing on time freezes the discharge, shifts the burden to the hospital to prove the discharge is appropriate, and protects you from paying for the extra days while an independent reviewer decides. Patients with private insurance or Medicaid have separate paths with their own deadlines, covered below.
The Notice That Starts Your Clock
Within two days of being admitted as an inpatient, every Medicare beneficiary should receive a document called “An Important Message from Medicare,” often shortened to the IM. It explains your right to appeal and lists the phone number of the BFCC-QIO in your state.1Medicare.gov. Fast Appeals If nobody handed it to you, ask. The hospital is required to deliver it.
Before you actually leave, the hospital must give you a follow-up copy of the IM. Federal rules say this second copy should come as far in advance of discharge as possible, and no more than two calendar days before the planned discharge date. When discharge cannot be predicted and the follow-up copy arrives on the day you are leaving, the hospital has to give you at least four hours to decide whether to appeal. You cannot be pressured out the door during that window.2Centers for Medicare & Medicaid Services. CMS Manual System – Pub 100-04 Medicare Claims Processing Transmittal
The same notice and appeal process applies whether you have Original Medicare or a Medicare Advantage plan. For Medicare Advantage enrollees, the BFCC-QIO still handles the review and notifies both the hospital and your plan.
How to File the Appeal
The appeal must be made no later than the day you are scheduled to be discharged. You can file by phone or in writing. Call the BFCC-QIO using the number on your IM.3eCFR. 42 CFR 405.1206 – Expedited Determination Procedures for Inpatient Hospital Care Do it while you are still physically in the hospital.
Have ready the patient’s full name, the date of admission, the Medicare number from the card, and the name of the hospital. Then give a clear, concrete reason the discharge feels unsafe. Specific medical facts carry more weight than a general objection. “I still cannot walk to the bathroom without falling.” “My pain medication was changed yesterday and has not been evaluated.” “No one has shown me how to manage the wound care I will need at home.” That is the kind of thing a reviewer can work with.
You also have a legally enforceable right to see your own medical records, and the hospital cannot demand a reason for the request.4U.S. Department of Health & Human Services. Individuals’ Right Under HIPAA to Access Their Health Information The federal deadline for producing records is 30 calendar days, which is useless in a live discharge appeal. Many states set a shorter timeline. Ask medical records for expedited access and explain there is an active appeal in progress.
What Happens After You File
Once the BFCC-QIO receives your request, it contacts the hospital. By noon the day after that contact, the hospital must hand you a “Detailed Notice of Discharge.” This document lays out the hospital’s specific medical reasoning and identifies the Medicare coverage rule it says applies to your case.1Medicare.gov. Fast Appeals Read it carefully. If you have anything to add, tell the QIO. The reviewer may also call you, your doctor, or hospital staff to talk through the case.
One point most patients do not realize: the burden of proof is on the hospital, not on you. The hospital has to show the discharge is correct under Medicare’s medical necessity or coverage rules.3eCFR. 42 CFR 405.1206 – Expedited Determination Procedures for Inpatient Hospital Care Your job is to explain why you believe the discharge is premature. The hospital’s job is to justify it.
The BFCC-QIO must issue its decision within one day of receiving all the information it needs. In practice, most decisions come by the close of business the day after the appeal is filed.1Medicare.gov. Fast Appeals
Your Bill While the Review Is Pending
File on time and you cannot be forced to leave while the review is underway. You are not responsible for the cost of the extra days, aside from any standard deductibles or coinsurance you would owe anyway. For 2026, the Part A inpatient hospital deductible is $1,736 per benefit period.5Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
This is the practical reason to file before leaving. Walk out the door first and you lose the ability to stay covered while the reviewer works.
If the QIO agrees with you, Medicare keeps covering your stay for as long as it remains medically necessary. If the QIO sides with the hospital, your financial protection runs through noon the day after you receive the decision. Anything after that noon cutoff is your responsibility, and hospital inpatient charges can run several thousand dollars a day.1Medicare.gov. Fast Appeals
Someone Else Can File for You
If the patient is too sick, confused, or exhausted to handle the appeal, a family member or other trusted person can do it. Medicare uses form CMS-1696, “Appointment of Representative,” to authorize someone to act on the patient’s behalf. Both the patient and the representative sign and date it, and it stays valid for one year.6Centers for Medicare & Medicaid Services. Appointment of Representative Form CMS-1696 The representative can then make requests, present evidence, receive communications about the case, and access the patient’s medical information. Send the completed form to the same place you send the appeal.
If You Lose the First Review
The QIO decision is only the first of five appeal levels. The second level is a reconsideration by a Qualified Independent Contractor (QIC). To ask for it, you must contact the QIC identified in the QIO’s written decision no later than noon of the calendar day after you receive that decision.7HHS.gov. Level 2 Appeals – Original Medicare Parts A and B That is a very tight deadline. If you might want to keep fighting, start preparing the moment the QIO decision arrives, not after you have thought about it.
Higher levels exist beyond the QIC, and they involve minimum dollar thresholds in dispute. For hospital stays, those thresholds are almost always met, but the timelines get longer and the process more formal.
If You Missed the Deadline
Missing the day-of-discharge deadline weakens your position but does not end it. You can still ask the BFCC-QIO to review the case, but different rules apply and you lose the financial protection that comes with a timely filing. That means you may owe the hospital for days after the original discharge date.1Medicare.gov. Fast Appeals
If you have already left the hospital, you can request QIO review within 30 calendar days of discharge, or later if you can show good cause for the delay.3eCFR. 42 CFR 405.1206 – Expedited Determination Procedures for Inpatient Hospital Care A late appeal will not put you back in the hospital, but it can result in Medicare picking up days that were initially denied. The lesson is simple: if you have any doubt about whether the discharge is safe, make the call before you leave.
Watch for Observation Status
Here is where patients get blindsided. If the hospital classified you as an outpatient receiving “observation services” instead of admitting you as an inpatient, you are not an inpatient for Medicare purposes, even after several nights in a hospital bed. Your stay gets billed under Part B rather than Part A, and Medicare will not cover a skilled nursing facility stay afterward.8Medicare.gov. Appeal When a Hospital Changes Your Status From Inpatient to Outpatient
Starting February 14, 2025, Medicare patients gained the right to a fast appeal if their status is changed from inpatient to outpatient observation during a hospital visit. The hospital must give you a written notice explaining the change and your appeal rights, and you can contact the BFCC-QIO the same way you would for a discharge appeal.8Medicare.gov. Appeal When a Hospital Changes Your Status From Inpatient to Outpatient Ask early whether you have been admitted as an inpatient or placed under observation. The answer affects both your appeal rights now and your coverage after you leave.
If You Have Private Insurance
Private insurers are outside the Medicare QIO system, but federal law still gives you the right to challenge a discharge. There are two stages: an internal appeal handled by the insurance company, and an external review by an independent organization.
Call the member services number on the back of your insurance card and request an expedited internal appeal. Say the situation is urgent because you are facing an active discharge. Federal rules require expedited internal appeals in urgent care situations to be decided quickly. If the insurer upholds the discharge, you can request an external review, in which an independent reviewer looks at the case fresh, not bound by the insurer’s earlier decision.9eCFR. 45 CFR 147.136 – Internal Claims and Appeals and External Review Processes
Expedited external reviews must be decided within 72 hours of the request, sometimes faster depending on the medical urgency.10Healthcare.gov. External Review The insurer cannot charge you for the external review. It must contract with at least three independent review organizations and rotate assignments to prevent bias.9eCFR. 45 CFR 147.136 – Internal Claims and Appeals and External Review Processes For a standard, non-urgent external review you generally have four months from the denial notice to file, but in a discharge situation you want the expedited track. Ask for it explicitly and document that you asked.
If You Have Medicaid
Medicaid beneficiaries can challenge a discharge through a fair hearing. The state must let you request a hearing within 90 days of receiving the discharge notice, and an expedited hearing is available when a delay could jeopardize your health or ability to function.11eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries For expedited cases involving a transfer or discharge from a skilled nursing facility, the state must issue a final decision within seven working days of receiving your request.
Procedures vary by state because Medicaid is jointly administered by federal and state governments. Call your state Medicaid agency or ask the hospital social worker for the local process. If you are dually eligible for Medicare and Medicaid, you may have appeal rights under both programs and should use whichever is stronger for your situation.