The nurse mentions that discharge is planned for tomorrow morning. You look at your spouse — still unsteady, still in pain, still on IV medication — and you cannot see how tomorrow is going to work. Medicare anticipates exactly this moment. Every hospital inpatient has the right to a fast appeal of a discharge, decided by an independent reviewer, usually within about a day. It costs nothing, it does not affect future coverage, and while the review is pending you generally are not billed for the additional time. The catch is timing: the right expires quickly, and it depends on a notice most people set aside without reading. Here is how the process works.
The Notice That Starts Everything
The Important Message from Medicare — often called the IM — is the notice that explains your discharge appeal rights. Hospitals are required to deliver it:
- Within two calendar days of admission as an inpatient, and
- Again before discharge — generally up to two days before, and no later than four hours before you leave
It applies to people in Original Medicare and Medicare Advantage alike, and you or your representative must sign it. If you have not received one, ask the nurse or the hospital case manager for it. The notice lists the name and phone number of the organization that handles the appeal in your state.
Read it before signing. Signing does not mean you agree to be discharged; it acknowledges that you received the notice. The phone number on that page is the entire mechanism for the appeal.
Who Decides the Appeal
Appeals go to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for your state — an independent contractor that reviews Medicare quality and coverage questions. The QIO is not part of the hospital or your health plan. Its reviewers look at your medical record and the hospital's reasoning and decide whether continued inpatient care is medically necessary.
The Deadline and the Steps
- Call the BFCC-QIO number on the Important Message no later than the day you are scheduled to be discharged. Calling before midnight of that day preserves the protection described below. Appeals are started by phone, not online
- Say that you want to appeal the discharge. You do not need medical language — describing why you believe it is unsafe to leave is enough. A family member or representative may call on your behalf
- The hospital must give you a Detailed Notice of Discharge, generally by noon of the day after the QIO notifies it. This document states the specific reasons the hospital believes coverage should end
- The QIO reviews the record and typically must decide within one calendar day after it receives the information it needs
- The QIO calls you with the decision
While the appeal is pending, you generally cannot be billed for the hospital stay, other than applicable deductibles and coinsurance. In 2026, the Part A inpatient deductible is $1,736 per benefit period, with $434 per day coinsurance for days 61 through 90.
If the QIO Agrees With the Hospital
You become financially responsible for continued hospital charges beginning at noon on the calendar day after you receive the QIO's decision. In practice, that gives you time to arrange a safe discharge — transportation, home equipment, a caregiver, or a transfer.
You may also request a second-level review from an independent review entity if you disagree with the QIO's decision. Our guide to appealing a Medicare decision describes the full appeals ladder.
If You Miss the Deadline
You may still ask the QIO to review the case, but different rules and timeframes apply, and you may be responsible for the cost of the stay beyond the original discharge date. If the deadline has passed, call the QIO anyway and explain the situation — and ask the hospital case manager about discharge planning options in parallel.
The Same Right Applies to Other Settings
Fast appeals are not limited to hospitals. If Medicare-covered services are ending in a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice, you should receive a Notice of Medicare Non-Coverage (NOMNC) at least two days before coverage ends.
- The deadline is earlier than you would expect: you generally must call the QIO by noon of the day before services are scheduled to end
- The provider must then give you a Detailed Explanation of Non-Coverage, and the QIO decides quickly, typically by the end of the following day
- Coverage generally continues while the review is pending
This matters most in skilled nursing, where coverage frequently ends before families expect it. Our guides to skilled nursing facility coverage and inpatient rehabilitation explain the underlying coverage rules — including the requirement of a qualifying three-day inpatient hospital stay before Medicare-covered skilled nursing care.
The Observation Status Trap
These discharge appeal rights belong to inpatients. If you are in a hospital bed under observation status, you are technically an outpatient — billed under Part B rather than Part A, and not covered by the Important Message process. Instead, hospitals must give observation patients a different notice, the Medicare Outpatient Observation Notice (MOON), when observation care lasts more than 24 hours.
The distinction has real consequences, including for skilled nursing coverage afterward. Our guide to outpatient surgery and observation stays covers what to ask and when. The practical step while someone is still in the hospital: ask directly whether they are admitted as an inpatient or under observation, and ask the case manager to explain the basis for the status.
Medicare Advantage Enrollees
If you are in a Medicare Advantage plan, you have the same fast appeal rights through the same BFCC-QIO process for hospital discharges and for services ending in skilled nursing, home health, and rehabilitation settings. Separately, your plan has its own appeals process for coverage denials — including denials of a skilled nursing stay or continued days. It is often worth pursuing both paths: the QIO fast appeal for the immediate discharge, and the plan appeal for the underlying coverage decision.
Practical Tips
- Ask for the Important Message if you were not given one, and keep it where you can find it
- Talk to the hospital case manager or social worker early. Many discharge disputes resolve through a revised discharge plan rather than an appeal
- Be specific about what is unsafe — no one at home during the day, stairs, unmanaged pain, an unresolved infection, no way to get medications
- There is no charge to file an appeal, and doing so does not affect future Medicare coverage
- A representative may act for you — a spouse, adult child, or anyone you authorize
- Write down names, times, and what was said. Documentation helps at every stage
- Keep planning in parallel. Even a successful appeal usually buys days, not weeks
How to Get Help and Learn More
- Medicare.gov — See the official page on fast appeals at medicare.gov/providers-services/claims-appeals-complaints/appeals/fast-appeals.
- 1-800-MEDICARE (1-800-633-4227) — Can identify the BFCC-QIO for your state if you do not have the notice. TTY users can call 1-877-486-2048.
- State Health Insurance Assistance Program (SHIP) — SHIP counselors provide free, unbiased help with discharge appeals and next-step coverage questions, at shiphelp.org.
Summary and Next Steps
- Hospitals must deliver the Important Message from Medicare within two days of admission and again before discharge
- To appeal, call the BFCC-QIO listed on the notice no later than the day of the planned discharge
- The hospital must then provide a Detailed Notice of Discharge, and the QIO generally decides within one calendar day
- You generally are not billed for the stay while the appeal is pending; if the QIO upholds the discharge, responsibility begins at noon the day after you receive the decision
- The same fast appeal process applies when services end in a skilled nursing facility, home health agency, rehabilitation facility, or hospice — with a NOMNC notice and a noon the day before deadline
- Observation status patients receive a MOON notice instead and do not have these inpatient discharge appeal rights
- Medicare Advantage enrollees have the same rights
If you are standing in a hospital room right now: find the Important Message, call the number on it today, and tell the case manager you have filed an appeal. Both conversations can happen in the same hour.
