Discharged From Medicare Too Soon? How to Appeal

What This Means

Medicare or your plan has determined that your medical condition no longer requires the level of care you are receiving — in a hospital or skilled nursing facility (SNF) — and has set a date for your coverage to end. Getting this notice feels abrupt, and the financial stakes are real. What many people don’t know is that you have a legal right to appeal that decision before you leave, and if you request the appeal in time, you can typically stay put while it is reviewed.

Why This Happens

• Medicare’s clinical criteria are not always aligned with how you feel. Coverage decisions are based on whether your condition meets specific medical criteria, not solely on whether you or your doctor believe more time is needed.
• Utilization reviewers flag cases for discharge. Hospitals and SNFs have internal teams that monitor patient status against Medicare’s coverage guidelines. When those guidelines are no longer met on paper, a discharge notice is generated.
• Your progress has been reclassified. In an SNF, Medicare Part A covers skilled care — meaning daily nursing or therapy with a measurable goal. If your care is deemed maintenance rather than skilled improvement, coverage may be cut off.
• The documentation didn’t fully capture your condition. Medical records submitted to reviewers may not have reflected the full picture of your daily needs, which can lead to an earlier-than-warranted discharge decision.
• Medicare Advantage plans apply their own criteria. If you have a Medicare Advantage plan (a private plan that provides Medicare benefits), your plan’s reviewer — not Original Medicare — made this call, and the criteria can differ.
• Coverage sometimes ends on an administrative clock rather than a clinical one. A 2025 BFCC-QIO focused review of Medicare Advantage skilled nursing cases found that 92% of beneficiaries still required skilled services at the point their coverage was terminated, and that facilities often issued non-coverage notices around day 15 of covered care — a pattern that points to standard timelines rather than individual recovery driving the decision.

Should You Appeal?

What To Do Next

1. Read the notice immediately — and check which one you were given. The two notices start different clocks, so identify yours before you count days. A hospital gives you the Important Message from Medicare About Your Rights (the “IM”), normally within 2 days of admission and again before you are discharged. A SNF, home health agency, or CORF gives you the Notice of Medicare Non-Coverage (NOMNC) at least 2 days before covered services end (fast appeals).

2. Request the fast appeal — your deadline depends on which notice you got. After a hospital discharge, your request must reach the QIO no later than the day you are scheduled to be discharged (42 CFR 405.1206). That clock runs to your discharge date, not to the day the IM was handed to you — since the IM usually arrives at admission, a stay of several days leaves you far more time than the notice’s date suggests. After a SNF, home health, or CORF termination, request it by noon of the day after you receive the NOMNC (42 CFR 405.1202). Miss the deadline that applies to you and you may owe for days of care you could have kept covered.

3. Send it to the reviewer on your notice, not to your plan. Under Original Medicare, both requests go to your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) — the federally contracted reviewer listed on your notice — not to Medicare directly. Under Medicare Advantage, a hospital discharge goes to that same BFCC-QIO (42 CFR 422.622), and a SNF, home health, or CORF termination goes to a Medicare-contracted independent review entity (42 CFR 422.626). Routing a fast appeal to your plan instead can burn the deadline.

4. Tell your doctor right away. Your physician’s support is the most important piece of your appeal. Ask them to confirm in writing — to you and to the reviewer — that continued care is medically necessary.

5. Stay in place while the appeal is under review. A timely hospital request means you are not financially responsible for inpatient services furnished before noon of the calendar day after you are notified of the QIO’s decision, apart from any coinsurance and deductible (42 CFR 405.1206). Decisions come quickly: on a hospital discharge the QIO decides within one calendar day of receiving the information it needs, and in other settings by close of business the day after (fast appeals).

6. If the first decision goes against you, ask about the next level of appeal. A denial at the fast-track level is not the end. You can escalate through Medicare’s standard appeals process — reconsideration, then an administrative law judge hearing, and beyond. Each level has its own deadline, so act promptly.

7. Call 1-800-MEDICARE (1-800-633-4227) or your State Health Insurance Assistance Program (SHIP) if you need help. SHIP counselors are free, unbiased, and experienced with discharge appeals. They can walk you through the process specific to your state.

Sources

• Medicare.gov — Fast appeals
• 42 CFR 405.1206 — Expedited determination procedures for inpatient hospital care
• 42 CFR 405.1202 — Expedited determination procedures for provider service terminations
• 42 CFR 422.622 — Requesting immediate QIO review of a hospital discharge (Medicare Advantage)
• 42 CFR 422.626 — Fast-track appeals of service terminations to independent review entities (Medicare Advantage)
• Medicare.gov — How to file a complaint or appeal
• Medicare.gov — Original Medicare appeal levels
• Medicare.gov — Skilled nursing facility (SNF) care
• Medicare.gov — Inpatient hospital care
• CMS — Report to Congress: The Administration, Cost, and Impact of the QIO Program, Fiscal Year 2025 (July 2026) — Table 6, discharge appeal volume and outcomes
• CMS — Beneficiary and Family Centered Care (BFCC)-QIOs

Frequently Asked Questions