If you're on Medicare and a hospital says you're being discharged before you feel ready, you have a legal right to an immediate appeal, and you get to stay in the hospital at no extra cost while an independent reviewer decides. This is called a fast (or expedited) appeal, and it goes to a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), not the hospital. You must request it no later than the day you're scheduled to leave. Miss that window and the process gets slower and can cost you money. This guide walks through exactly how the discharge appeal works in 2026, including a new observation-status appeal right that didn't exist a few years ago.
What Is the "Important Message from Medicare" Notice
Within two calendar days of being admitted as a hospital inpatient, you or your representative should receive a form called "An Important Message from Medicare about Your Rights" (often shortened to the IM or IMM). Hospitals are required to give this to every Medicare inpatient, including people enrolled in a Medicare Advantage plan.
The notice explains two things in plain language:
- You have the right to appeal a discharge decision if you think you're being sent home too soon.
- The name and phone number of the BFCC-QIO that handles appeals in your area.
You'll also get a second copy of the same notice no more than two days before your actual discharge date, as a reminder of your rights right before you leave. If a hospital never gave you this notice, your discharge appeal clock may not have legally started, which is worth raising directly with the hospital's patient advocate or the BFCC-QIO.
Your Right to an Immediate BFCC-QIO Appeal
The BFCC-QIO is an independent medical review organization under contract with Medicare. It is not part of the hospital and does not answer to your doctor's employer. When you file a fast appeal, the QIO pulls your medical record and makes an independent judgment about whether you're medically ready to leave.
| Original Medicare | Medicare Advantage |
|---|
| Who reviews the appeal | BFCC-QIO for your state | Same BFCC-QIO for your state |
| Deadline to request | By midnight the day you're scheduled to be discharged | By midnight the day you're scheduled to be discharged |
| Cost while you wait | $0 extra (normal coinsurance/deductibles still apply) | $0 extra (normal coinsurance/deductibles still apply) |
| QIO decision timeline | Within 1 calendar day of receiving all needed records | By the day your care was scheduled to end |
| Notice you receive after filing | Detailed Notice of Discharge, by noon the day after the hospital is notified | Detailed Notice of Discharge, same timing |
| What happens if you lose | You may be responsible for costs starting at noon the day after you get the QIO's decision | Same |
The key detail people miss: filing on time is what protects you financially. If you appeal before midnight on your scheduled discharge day, you cannot be billed for the extra hospital days while the QIO reviews your case, no matter how the appeal turns out. If you wait even one day too long, that protection disappears.
Step-by-Step: How to File a Fast Discharge Appeal
- Read the Important Message from Medicare as soon as you get it, not the day you're being sent home. It has the phone number for your state's BFCC-QIO printed on it.
- Call the BFCC-QIO directly, before midnight on your scheduled discharge date. You can also have a family member, caregiver, or patient advocate call on your behalf.
- Tell them you want a fast appeal (also called an expedited appeal or immediate review) of your discharge. You do not need to fill out a form to start this. A phone call is enough.
- Give the QIO your Medicare number, hospital name, and the reason you disagree with the discharge. Be specific: you're still in pain, you can't manage your medications alone, your wound isn't healing, your caregiver isn't ready, or your chronic condition (heart failure, COPD, diabetes complications) hasn't stabilized.
- The hospital must send your medical records to the QIO and give you a Detailed Notice of Discharge by noon the day after the hospital is notified of your appeal. This notice explains the specific medical reason the hospital believes you're ready to leave.
- Stay in the hospital while you wait. You have the right to remain until the QIO issues its decision, and you will not owe anything extra for that time if you filed before the deadline.
- Get the decision. The QIO typically calls you directly with the outcome within one calendar day of receiving your complete medical record. If the decision favors you, your covered stay continues. If it favors the hospital, you can be discharged and may owe costs for any days after that point.
What Happens After You File
Two BFCC-QIOs currently handle these reviews across the country: Acentra Health (formerly known as Kepro) and Commence Health (formerly known as Livanta, which was renamed in August 2025). Which one covers you depends on your state, and the phone number is printed directly on your Important Message from Medicare notice, so you don't need to guess.
Once the QIO has your complete file, it typically issues a decision by phone within 24 hours. If you disagree with an unfavorable decision, you generally have the option to request a second, higher-level review, and the notice you receive will explain how.
If You Miss the Discharge Deadline
If your scheduled discharge date has already passed and you didn't request a fast appeal in time, you can still ask the BFCC-QIO to review your case, but the rules change:
- You may be billed for the hospital stay from the point the hospital wanted to discharge you until the QIO's decision comes back.
- The review can still result in Medicare covering additional days if the QIO agrees you weren't ready, but you're taking on financial risk in the meantime that on-time appeals avoid entirely.
- As of January 2, 2026, a separate 365-day window that used to allow retrospective appeals for certain inpatient-versus-observation status disputes has closed. New retrospective status appeals filed after that date will generally be denied unless there's good cause for the delay.
The takeaway is simple: call the BFCC-QIO the moment you disagree with a discharge plan, not after you've already been sent home.
New in 2025-2026: Appealing an Observation Status Change
Since February 14, 2025, Medicare beneficiaries have had a new right that didn't previously exist: the ability to request a fast appeal if a hospital changes your status from "inpatient" to "outpatient receiving observation services" during your stay. This right came out of a class-action lawsuit (Alexander v. Becerra) and matters because observation status can affect what you pay and whether you later qualify for Medicare-covered skilled nursing facility care.
Separately, hospitals must give you a Medicare Outpatient Observation Notice (MOON) if you're held in observation status for more than 24 hours, explaining that you're not formally admitted as an inpatient. CMS issued an updated version of the MOON effective April 21, 2026. One important distinction: you cannot file an appeal directly from the MOON itself, but if your status changes from inpatient to observation during your stay, you can appeal that specific change through the BFCC-QIO fast-appeal process described above.
If you're managing a chronic condition and a hospital tells you mid-stay that you've been switched to observation, ask directly whether that change affects your discharge planning and whether it opens up a status appeal, not just a discharge appeal. They are two different rights.
Get Free Help With a Discharge Dispute
Fighting a hospital discharge decision while also managing a chronic condition like heart failure, COPD, or diabetes is a lot to handle on a deadline measured in hours, especially if you're the one making the phone calls from a hospital bed. Benefits Navigator connects Medicare beneficiaries managing chronic conditions with a free care advocate service that helps you understand your discharge notice, contact the right BFCC-QIO, gather supporting documentation from your doctor, and coordinate what happens after you leave the hospital, including home health and follow-up care. There's no cost to use it. Take our quick quiz to see if you qualify for free Medicare care advocacy support at /quiz.
Frequently Asked Questions
How much time do I have to appeal a Medicare hospital discharge?
You must request a fast appeal from the BFCC-QIO no later than midnight on the day you're scheduled to be discharged. This is listed on the Important Message from Medicare notice you receive at admission and again before discharge.
Will I have to pay for extra hospital days while my appeal is pending?
No, as long as you filed your fast appeal before the deadline. You won't owe anything beyond your normal coinsurance or deductible while the BFCC-QIO reviews your case. If you miss the deadline and request a late review, you may be billed for the stay while the review is pending.
How long does the BFCC-QIO take to decide?
For Original Medicare, the QIO typically issues a decision within one calendar day of receiving your complete medical record from the hospital. For Medicare Advantage enrollees, the decision generally comes by the day your covered care was scheduled to end.
What if I never received the Important Message from Medicare notice?
Hospitals are required to give it to you within two days of admission and again before discharge. If you never received it, tell the hospital's patient advocate and contact your state's BFCC-QIO directly. The absence of the notice can affect the validity of your discharge timeline.
Does Medicare Advantage give me the same discharge appeal rights as Original Medicare?
Yes. Medicare Advantage enrollees have the same right to an immediate BFCC-QIO review of a hospital discharge as people with Original Medicare. The main difference is the decision timing: Original Medicare allows up to one day after the review is complete, while Medicare Advantage decisions generally come by the scheduled end-of-care date.
Can I appeal if a hospital changes me from inpatient to observation status?
Yes, as of February 14, 2025. If your status changes from inpatient to outpatient observation during your hospital stay, you can request a fast appeal of that specific change through the same BFCC-QIO process used for discharge appeals.
Who do I call to start a fast discharge appeal?
The phone number for your state's BFCC-QIO is printed on your Important Message from Medicare notice. The two organizations currently handling these reviews nationwide are Acentra Health and Commence Health, depending on your state.
Can a family member or caregiver file the appeal for me?
Yes. A family member, caregiver, or authorized representative can call the BFCC-QIO and request the fast appeal on your behalf, which matters if you're too unwell to make the call yourself.
