Medicare 2026

How to Appeal a Hospital Discharge: Using the Important Message From Medicare

If a hospital tells you or a loved one it's time to go home, and something about that decision doesn't feel right, you have the right to push back. Medicare builds in a fast, free appeal process designed to happen while the patient is still in the hospital bed, not after the fact. The key to using it is a form the hospital is required to hand you called "An Important Message from Medicare about Your Rights" — usually just called the IM.

Here's how the process works, no matter where you live or whether you have Original Medicare or a Medicare Advantage plan.

What the "Important Message" is

The IM is a plain-language notice the hospital is required to give to every Medicare patient admitted as an inpatient — whether they're in Original Medicare or a Medicare Advantage plan. It explains that you have a right to receive Medicare-covered services for as long as they are medically necessary, a right to be involved in discharge planning, and a right to a fast independent review if you think discharge is being pushed too soon.

The hospital must deliver the IM at or near admission, and no later than 2 calendar days after you're admitted. Then, before you leave, they have to present it to you again — as far in advance as possible, but not more than 2 calendar days before discharge. You'll be asked to sign it; signing only confirms you received it, not that you agree with the discharge plan.

Keep this paper. It has the phone number you'll need.

Who decides the appeal

Appeals go to a BFCC-QIO — an independent organization under contract with CMS to review quality and discharge concerns for Medicare patients. There are two BFCC-QIOs nationally: Acentra Health (formerly Kepro) and Commence Health (formerly Livanta). Each one serves a different group of states, and CMS posts a region map showing which QIO covers each state. The IM you receive will list the correct QIO and its phone number for your location.

How to file the appeal

To appeal a discharge, you — or someone acting on your behalf, like a family member — follow the directions on the IM and contact the listed BFCC-QIO, in writing or by phone, no later than the day of discharge. The sooner you call, the better; weekend and holiday hours are available because discharges don't wait for business days.

Once you file:

• The hospital must give you a Detailed Notice of Discharge explaining why services are ending, no later than noon of the day after the QIO is notified.
• In Original Medicare, the hospital carries the burden of showing that discharge is the right decision. In Medicare Advantage, the plan carries that burden.
• The QIO must decide and notify you within one calendar day after it receives all the information it asked for.

While you wait, you can remain in the hospital. You are not responsible for hospital charges during the appeal, other than your usual coinsurance or deductibles, and you are not responsible for charges incurred through noon of the day after the QIO issues its decision.

If the QIO sides with the hospital

In Original Medicare, if you're still in the hospital and disagree with the QIO's decision, you can take it one step further: ask a Qualified Independent Contractor (QIC) for an expedited reconsideration by noon of the calendar day after you were notified of the QIO's decision.

In Medicare Advantage, if the QIO rules the discharge was premature, your coverage continues for as long as it's medically necessary — provided the plan had authorized the admission or the admission was for emergency or urgently needed care. The QIO notifies both the hospital and the plan of its decision.

If you miss the deadline

Life moves fast in a hospital, and sometimes the window closes before you realize you wanted to appeal.

• In Original Medicare, you can still ask the QIO for a review while you're in the hospital (decided within 2 calendar days), or within 30 calendar days after discharge, or later if you have good cause (decided within 30 calendar days). The catch: the financial protection for the extra hospital days no longer applies, so you could be responsible for charges during those additional days.
• In a Medicare Advantage plan, if you miss the day-of-discharge deadline, you can ask the plan itself for an expedited reconsideration.

A few practical tips

• Read the IM when it's handed to you. Don't tuck it in a drawer. The phone number you need is on it.
• Act the same day you're told discharge is coming. The day-of-discharge deadline is the one that preserves your financial protection.
• Anyone can appeal on the patient's behalf — a spouse, adult child, friend, or legal representative. You don't need a lawyer.
• Ask the hospital's case manager or patient advocate for help gathering medical records that support staying longer.
• Keep copies of every notice: the IM, the Detailed Notice of Discharge, and any decision letters.

Where to learn more

The discharge appeal process is the same nationwide, but the specific QIO contact depends on your state and is listed on your IM. For more on your Medicare rights, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week. TTY users can call 1-877-486-2048.

Knowing this process exists — and acting quickly when it matters — can make the difference between a safe recovery and a rushed one.