Appeal a discharge, fast
For patients in Medicare or Medicare Advantage. Medicare calls it a fast appeal, and the notice may say expedited appeal, which is the same thing.
No Medicare, and told to leave?
A Medicare Advantage plan is Medicare. If you were admitted as an inpatient, not held for observation, you can use the fast appeal. Ask the Medicare review office before you leave, by the planned discharge day, using the number on the notice called An Important Message from Medicare. Other health plans may have a fast appeal of their own. Whatever your plan, there are four things you can do today, and each one leaves a written record.
- Say in writing that you do not agree, and why.
Give a short note to your nurse and the case manager, and ask that it go in the chart. Ask for the written discharge plan, the medical reason, and the name of the doctor who decided. A federal rule says hospitals must include patients in discharge planning, and must do a discharge planning evaluation if you ask (42 CFR 482.43). The page Other letters has a letter called "Ask for more days before discharge".
- File a grievance with the hospital.
A grievance is a formal complaint to the hospital, and when the hospital resolves it, it must send a written decision (42 CFR 482.13). Use the word "grievance" in your letter. The page Report a care or safety problem shows how.
- If a health plan is ending the coverage, ask the plan.
A Medicaid plan or a private insurer sends its own notice, and that notice names the appeal and the deadline. Call the number on it and ask for the appeal in writing.
- If you believe the discharge is unsafe, tell the state.
The state health office takes complaints about hospitals, and the page Who has to answer lists the office for your state.
Keep a copy of everything you send, and the day you sent it. The page What you sent, and what came back keeps the list.
If the answer is no: a hospital stay
Start at the level that matches the paper you hold.
- Step 1Fast appeal by phone
Medicare review office
Call the Medicare review office before you leave and say you disagree with going home today. You may stay while they decide.
Time to ask: By day of discharge (405.1206(b)(1))
The count starts: The planned discharge day on your paper, so call before you leave.
- If you are lateLate fast appeal
Medicare review office
If the deadline has passed, call anyway. They can still review it, but the fast timing and the right to stay may not apply.
Time to ask: Still inpatient: any time; discharged: 30 days from discharge date, or good cause any time (405.1206(b)(5)-(6))
The count starts: The day you left the hospital, or any time while you are still in it.
- Step 2Second review
Second reviewer
If the first review says no and you are still in the hospital, call the second reviewer by noon the next day.
Time to ask: By noon the day after the review office tells you (405.1204(b)(1))
The count starts: The day the review office told you, by phone or on paper.
- Step 3Judge hearing
Judge hearing (OMHA)
A judge hears your case, and you file within 60 days. This step has a minimum dollar amount.
Time to ask: 60 days from receipt of second reviewer decision, receipt presumed 5 days after notice date (405.1014(c))
The count starts: The date on the letter, plus 5 days for the mail.
Judge hearing needs a minimum amount: $200 in 2026, $200 from 1 January 2027.
- Step 4Review board
Review board (Medicare Appeals Council)
A review board rereads the file, and you file within 60 days. There is no hearing and no dollar limit.
Time to ask: 60 days from receipt of judge decision or dismissal (405.1102); presumed 5 days after notice date
The count starts: The date on the judge letter, plus 5 days for the mail.
- Step 5Federal court
Federal court
A federal court is the last step, and you have 60 days. A lawyer or legal aid can write the court papers.
Time to ask: 60 days from receipt of Council decision, presumed 5 days after notice (405.1130, 405.1136(c)(2)); or 60 days after Council says it cannot decide in time (405.1132(b))
The count starts: The date on the review board letter, plus 5 days for the mail.
Federal court needs a minimum amount: $1,960 in 2026, $2,000 from 1 January 2027.
If rehab, home health, hospice or outpatient therapy is ending
If the answer is no: care is ending
- Step 1Fast appeal by phone
Medicare review office
Call the review office right away and tell them you want the care to continue. Ask your doctor to back you with a note.
Time to ask: Call as soon as you get the notice, and no later than noon the day before the last covered day. If your paper gives an earlier time, the earlier time counts (405.1202).
The count starts: The day you got the notice. If your paper gives an earlier time, the earlier time counts.
- If you are lateLate fast appeal
Medicare review office
If the deadline has passed, call anyway. They can still review it, but the fast timing and the right to stay may not apply.
Time to ask: None fixed; take any time (405.1202(b)(4))
- Step 2Second review
Second reviewer
If the review office says care can end, ask the second reviewer by noon the next day.
Time to ask: By noon the day after the review office tells you (405.1204(b)(1))
The count starts: The day the review office told you, by phone or on paper.
- Step 3Judge hearing
Judge hearing (OMHA)
A judge hears your case, and you file within 60 days. This step has a minimum dollar amount.
Time to ask: 60 days from receipt of second reviewer decision, receipt presumed 5 days after notice date (405.1014(c))
The count starts: The date on the letter, plus 5 days for the mail.
Judge hearing needs a minimum amount: $200 in 2026, $200 from 1 January 2027.
- Step 4Review board
Review board (Medicare Appeals Council)
A review board rereads the file, and you file within 60 days. There is no hearing and no dollar limit.
Time to ask: 60 days from receipt of judge decision or dismissal (405.1102); presumed 5 days after notice date
The count starts: The date on the judge letter, plus 5 days for the mail.
- Step 5Federal court
Federal court
A federal court is the last step, and you have 60 days. A lawyer or legal aid can write the court papers.
Time to ask: 60 days from receipt of Council decision, presumed 5 days after notice (405.1130, 405.1136(c)(2)); or 60 days after Council says it cannot decide in time (405.1132(b))
The count starts: The date on the review board letter, plus 5 days for the mail.
Federal court needs a minimum amount: $1,960 in 2026, $2,000 from 1 January 2027.
If a Medicare Advantage plan is ending your care
If the answer is no: your plan ends care
- Step 1Fast appeal by phone
Medicare review office
Call the Medicare review office as soon as you get the notice. They answer fast, often the next day.
Time to ask: Call as soon as you get the notice, and no later than noon the day before the last covered day. If your paper gives an earlier time, the earlier time counts (422.626).
The count starts: The day you got the notice. If your paper gives an earlier time, the earlier time counts.
- If you are lateAsk your plan for a fast review
Your plan
Say your doctor thinks waiting could harm you.
Time to ask: 60 days from receipt of the plan's written decision (422.584(b); presumed 5 days after notice date (422.584(b)(3)))
The count starts: The date on the plan notice, plus 5 days for the mail.
- Step 2Ask the review office to look again
Medicare review office
If the review office says no, you can ask it to look again within 60 days of its notice. It answers within 14 days.
Time to ask: 60 days from notice that outside reviewer upheld (422.626(g)(1)); outside reviewer decides in 14 days
The count starts: The date on the review office notice that said no.
- Step 3Judge hearing
Judge hearing (OMHA)
A judge hears your case, and you file within 60 days. This step has a minimum dollar amount.
Time to ask: 60 days from receipt of second reviewer decision, receipt presumed 5 days after notice date (405.1014(c))
The count starts: The date on the letter, plus 5 days for the mail.
Judge hearing needs a minimum amount: $200 in 2026, $200 from 1 January 2027.
- Step 4Review board
Review board (Medicare Appeals Council)
A review board rereads the file, and you file within 60 days. There is no hearing and no dollar limit.
Time to ask: 60 days from receipt of judge decision or dismissal (405.1102); presumed 5 days after notice date
The count starts: The date on the judge letter, plus 5 days for the mail.
- Step 5Federal court
Federal court
A federal court is the last step, and you have 60 days. A lawyer or legal aid can write the court papers.
Time to ask: 60 days from receipt of Council decision, presumed 5 days after notice (405.1130, 405.1136(c)(2)); or 60 days after Council says it cannot decide in time (405.1132(b))
The count starts: The date on the review board letter, plus 5 days for the mail.
Federal court needs a minimum amount: $1,960 in 2026, $2,000 from 1 January 2027.
If you missed the call: ask your plan
- Step 1Ask your plan for a fast review
Your plan
Say your doctor thinks waiting could harm you.
Time to ask: 60 days from receipt of the plan's written decision (422.584(b); presumed 5 days after notice date (422.584(b)(3)))
The count starts: The date on the plan notice, plus 5 days for the mail.
- Step 2The plan decides again
Your plan
If the plan says no, it must send your case to an outside reviewer for you.
Time to ask: Ask plan within 60 days of the written notice (422.584(b)); plan: 72 hours expedited, 30 days standard (422.590)
The count starts: The date on the plan notice, plus 5 days for the mail.
- Step 3Outside reviewer
Outside reviewer (IRE)
If the outside reviewer says no, you can ask a judge within 60 days.
Time to ask: judge request 60 days from receipt, presumed 5 days after notice (422.602(b))
The count starts: The date on the letter, plus 5 days for the mail.
- Step 4Judge hearing
Judge hearing (OMHA)
A judge hears your case, and you file within 60 days. This step has a minimum dollar amount.
Time to ask: 60 days from receipt of second reviewer decision, receipt presumed 5 days after notice date (405.1014(c))
The count starts: The date on the letter, plus 5 days for the mail.
Judge hearing needs a minimum amount: $200 in 2026, $200 from 1 January 2027.
- Step 5Review board
Review board (Medicare Appeals Council)
A review board rereads the file, and you file within 60 days. There is no hearing and no dollar limit.
Time to ask: 60 days from receipt of judge decision or dismissal (405.1102); presumed 5 days after notice date
The count starts: The date on the judge letter, plus 5 days for the mail.
- Step 6Federal court
Federal court
A federal court is the last step, and you have 60 days. A lawyer or legal aid can write the court papers.
Time to ask: 60 days from receipt of Council decision, presumed 5 days after notice (405.1130, 405.1136(c)(2)); or 60 days after Council says it cannot decide in time (405.1132(b))
The count starts: The date on the review board letter, plus 5 days for the mail.
Federal court needs a minimum amount: $1,960 in 2026, $2,000 from 1 January 2027.
If your plan wants you out of the hospital
- Step 1Fast appeal by phone
BFCC-QIO
In a plan, call the review office by the day you leave to appeal discharge. The hospital must show the discharge is right.
Time to ask: No later than the day of discharge; phone or writing
The count starts: Planned discharge day
- Step 2Ask your plan for a fast review
Medicare Advantage plan
If your doctor says waiting could seriously harm you, the plan must speed it up.
Time to ask: Ask within 60 calendar days of the written notice; plan decides in 72 hours when it expedites; a physician statement makes expedite mandatory
The count starts: Date of plan written notice
- Step 3Outside reviewer
Part C Independent Review Entity: C2C Innovative Solutions
If your plan keeps its refusal, it must send your case to an outside reviewer for you. You do not have to ask.
Time to ask: Plan must send the file automatically; expedited 72 hours, standard 30 days
The count starts: Plan decision
- Step 4Judge hearing
OMHA
This level may need a minimum amount in dispute.
Time to ask: The minimum amount changes each January.
The count starts: outside reviewer notice date + 5 days
- Step 5Review board and court
Medicare Appeals Council; US district court
The last steps in a plan appeal are the same: the Appeals Council, then federal court, each within 60 days.
Time to ask: Council: 60 days from receipt of judge decision; court: 60 days after Council decision
The count starts: Notice date + 5 days
Where is the patient right now?
Your deadline
Appeal no later than the day of the planned discharge, before you leave (42 CFR 405.1205). Your notice has the date. Your notice is An Important Message from Medicare (the IM). The hospital must give you this notice when you are admitted, and again before you leave (42 CFR 405.1205). Ask for it if you did not get it.Your deadline
Call as soon as you get the notice, and no later than noon the day before the last covered day (42 CFR 405.1202). Your notice has the date. Your notice says your services are ending, and it is often called the NOMNC.Upload your medical documentation
The rules, in full
Have in front of you
- The notice, which has the Medicare review office name and number.
- The patient's Medicare number
- A pen, to write down a case number, a time, and a name.
- Call the Medicare review office number on the notice. Say: "I am requesting a fast appeal of this discharge."
Follow the contact instructions on the notice. Ask the reviewer to confirm receipt of your appeal and record the date and time.
- Write down the case number, the date and time of your call, and the name of anyone you speak with.
Keep these details with your notice and any written response.
- The reviewer will ask why you are appealing.
Say what treatment is still running, what the patient cannot do yet, and what changed in the last days, in your own words.
Ask for the written explanation of the decision. It must give the specific reasons.
- If you ask in time, you may be able to stay while the reviewer decides.The timing is different here from a hospital.
If you ask in time, you can stay while the reviewer decides. Different rules apply if you miss the deadline.Ask for the review as soon as you get the notice, and no later than noon the day before the last covered day. Ask the provider, in writing, what will happen to your care from the end date, and keep the answer. Different rules apply if you miss the deadline.
- The reviewers read the record and call you.
Tell them what you have seen, with dates. If you have gathered records, offer them.
- The decision comes within about a day.
If the reviewer agrees with you, care continues. If the reviewer says no, the discharge can go ahead after the decision.If the reviewer says no, the end date on your notice stands. You can ask for a second review. The decision letter says how and by when.
- Read the next review instructions with each decision.
Keep each notice and decision, and ask which next appeal applies and by when, since a new notice does not always restart the deadline.
You can also ask the Medicare review office about help with care concerns. Asking for that help does not itself request an appeal.
Timing to check on your notice
In a hospitalIn rehab, a nursing facility, or home health Appeal by the day of the planned discharge (42 CFR 405.1205). The hospital must give you a Detailed Notice of Discharge. The review office decides within one day of getting the records (42 CFR 405.1206). Check your notice. Call as soon as you get the notice, and no later than noon the day before the last covered day (42 CFR 405.1202). The provider gives you a detailed written explanation. The review office usually decides by close of business the day after it gets what it needs. Check your notice.Official sources and timing details
Sources: Medicare, Fast appeals | CMS, BFCC-QIO program | CMS, Important Message from Medicare | CMS, Medicare notices (including the notice that your care is ending) | The rules: 42 CFR 405.1205 (the notice you must get), 42 CFR 405.1206 (the review by the Medicare review office), 42 CFR 405.1204 (the next level), 42 CFR 422.624 (Medicare Advantage plans). Deadlines and offices vary, so check your notice.