Blog
When home health ends: your right to a fast appeal
Medicare gives patients a quick way to challenge a decision to end covered home health services. The deadlines are short, so it helps to know them in advance.
The short answer
You should get a Notice of Medicare Non-Coverage at least 2 days before covered services end. To appeal, contact the BFCC-QIO listed on the notice by noon the day before services end. The reviewer decides by close of business the day after it has the information it needs.
The notice
Your home health agency should give you a Notice of Medicare Non-Coverage at least 2 days before covered services end. If you do not receive it, ask for it. The notice explains how to request a fast appeal and how to reach the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Texas (Medicare.gov).
The deadline
Follow the instructions on the notice no later than noon of the day before the termination date. The BFCC-QIO is an independent reviewer, not the agency.
What happens next
The reviewer decides by close of business the day after it receives the information it needs. If it decides services are ending too soon, Medicare may continue to cover home health depending on your care needs. If it agrees services should end, you are not responsible for services before the end date on the notice, but you may have to pay for services after that date.
How we handle discharge
We explain discharge plans in advance, give required notices on time and answer questions about appeal rights. Asking for an appeal will never affect how we treat you.
Questions
Quick answers
Does an appeal cost anything?
There is no charge to request a fast appeal from the BFCC-QIO.
Who can request the appeal?
The patient or their representative can follow the instructions on the notice.
Sources
General information only. This article is not medical, legal or coverage advice. Talk with your physician about your care. In an emergency, call 911. Please do not send patient health information through this website.
Read our editorial policy. More articles on the OceanCare Health blog.
Have a patient who could recover at home?
Request a callback and our intake team will follow up with next steps. Please do not send patient health information through this website.
Fax referrals and orders to (214) 614-7479
- Texas HCSSA rules
- Medicare Conditions of Participation
- Monthly exclusion screening
- No health data in web forms
- Free language help