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Getting a fast appeal from non-hospital settings

You have the right to a fast appeal if you think your services are ending too soon from one of these facilities: 

While you're getting SNF, HHA, CORF, or hospice services, you should get a notice called "Notice of Medicare Non-Coverage" at least 2 days before covered services end. If you don't get this notice, ask for it. This notice explains:

  • The date your covered services will end
  • That you may have to pay for services you get after the coverage end date given on your notice
  • Information on your right to get a detailed notice about why your covered services are ending
  • Your right to a fast appeal and information on how to contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in your state to request a fast appeal

How do I ask for a fast appeal?

Ask the BFCC-QIO for a fast appeal no later than noon of the first day after the day you get the "Notice of Medicare  Non-Coverage." Follow the instructions on the termination notice.

If you miss the deadline for requesting a fast appeal from the BFCC-QIO, you can request a fast reconsideration from your plan. But, services will only be covered if there's a decision issued in your favor.

What will happen during the BFCC-QIO's review?

When the BFCC-QIO gets your request, it will notify the provider. Then, by the end of the day that the provider gets the notice from the BFCC-QIO, the provider will give you a "Detailed Explanation of Non-Coverage." The notice will include:

  • Why your services will no longer be covered
  • The applicable Medicare coverage rule or policy, including a citation to the applicable Medicare policy, or information on how you can get a copy of the policy that's being used to explain why your coverage is ending
  • How the applicable Medicare coverage rule or policy applies to your situation

The BFCC-QIO will:

  • Ask why you believe coverage for the services should continue
  • Look at your medical records and the information provided by the plan
  • Make a decision by close of business the day after it gets the information it needs to make a decision

If the BFCC-QIO decides that your services are ending too soon:

Medicare may continue to cover your SNF, HHA, CORF, or hospice services (except for applicable coinsurance or deductibles).

If the BFCC-QIO decides that your services should end:

You won't be responsible for paying for any SNF, HHA, CORF, or hospice services provided before the termination date on the "Notice of Medicare Non-Coverage." If you continue to get services after the coverage end date, you may have to pay for those services.