The short answer: If your parent has Medicare and you believe a hospital discharge is too soon, call the Quality Improvement Organization (QIO) listed on the notice called An Important Message from Medicare about Your Rights no later than midnight of the planned discharge day. The review is free, and in most cases your parent can stay in the hospital without paying for the extra days while the QIO decides.
Most families learn this the hard way: standing in a hallway with a discharge date nobody prepared them for. Here is what to know before that moment.
What is the notice I should have received?
Hospitals must give people with Medicare, including Medicare Advantage, a notice called An Important Message from Medicare about Your Rights (often called the IM) within two days of admission, and usually again shortly before discharge. It explains the right to appeal and lists the phone number of your QIO. If you cannot find it, ask the nurse or case manager for a copy. It is your right to have it.
What is a QIO?
A Quality Improvement Organization is an independent group of doctors and health professionals that Medicare pays to review care and appeals. It does not work for the hospital. In most of the country, the QIO that handles appeals is called a Beneficiary and Family Centered Care QIO (BFCC-QIO).
How do I appeal?
- Call the QIO on the notice by midnight of the discharge day. Your parent can call, or you can call as their representative.
- Say you are requesting a fast appeal of the discharge and give the patient’s name, Medicare number and hospital.
- Tell the hospital that you have appealed. The hospital must then give you a detailed notice explaining why it believes discharge is appropriate.
- Explain your concerns to the QIO: what has changed, what the home is not set up for, what symptoms worry you. Be specific.
The QIO usually decides within about a day of getting the records it needs.
Will we have to pay for the extra days?
If you appeal on time, Medicare generally keeps paying for the hospital stay until the QIO decides, apart from the usual deductible and copays. If the QIO agrees with the hospital, coverage usually continues until noon of the day after you are told. If you miss the deadline, you can still ask for a review, but you may have to pay for days after the planned discharge date if you lose.
What if my parent is in observation status?
Observation is outpatient care, even if your parent is in a hospital bed for several nights. It matters because Medicare generally covers a skilled nursing facility stay only after three days as an admitted inpatient. The hospital must give a Medicare Outpatient Observation Notice (MOON) after 24 hours of observation. Since February 2025, people with Original Medicare whose status is changed from inpatient to observation have new rights to appeal that change in certain situations. Ask the case manager directly: is my parent inpatient or observation, and since when?
What about rehab, home health or hospice ending too soon?
A skilled nursing facility, home health agency or hospice must give a Notice of Medicare Non-Coverage at least two days before covered services end. To appeal, call the QIO on that notice by noon of the day before services are scheduled to end.
What should I bring to the conversation?
- The IM notice, with the QIO phone number circled
- A current medication list
- Notes on what has changed in the last 48 hours
- A plain description of the home: stairs, who is there at night, what equipment is missing
The Hospital Discharge Planning Kit includes a fill-in appeal script, the 22 questions to ask before discharge and a letter template. The free Caregiver Quick-Start Pages include the discharge questions and a one-page emergency summary. See also 22 questions to ask before a hospital discharge.
Common questions
Can I appeal for my parent?
Yes. A family member can call the QIO on the patient’s behalf. If your parent is able, have them confirm on the call that you can speak for them.
Does this apply to Medicare Advantage?
Yes. The IM notice and fast appeal to the QIO apply to Medicare Advantage hospital stays too.
Will appealing upset the care team?
It is a routine, legal right and hospitals handle these reviews regularly. Calm and specific works better than angry.
Tend & Keep Field Guide. Reviewed October 2026. Educational information, not legal or medical advice. Confirm details with the QIO on your notice or 1-800-MEDICARE.