The notice you should get
When you're admitted as an inpatient, the hospital must give you "An Important Message from Medicare about Your Rights" within 2 days of admission, and again before you leave if it gave you the first one more than 2 days before discharge. It explains your right to appeal and how to reach the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). For North Carolina, that's Acentra Health. If you don't get the notice, ask for it.
How to ask for a fast appeal
- Tell your doctor and the hospital you disagree. Ask why they think you're ready and whether follow-up care, such as skilled nursing or home health, is arranged.
- Call Acentra Health right away. Dial 1-888-317-0751 (TTY 711) no later than the day you're scheduled to leave, before you leave the hospital. Have your Medicare number and the notice handy.
- Get the hospital's explanation. By noon the day after Acentra Health notifies the hospital, the hospital gives you a "Detailed Notice of Discharge" explaining why it plans to discharge you.
- Wait for the decision. Acentra Health's doctor reviews your records and decides within one day after getting the information it needs. You don't have to leave while it reviews.
- If you disagree with the decision. Follow the instructions in the decision letter to ask for the next level of review.
Tip: A family member can call for you, and can file the appeal if you name them as your representative. If you were moved from a small hospital in the mountains or the east to a larger hospital in Charlotte, the Triangle or the Triad, you have the same rights at the hospital that admitted you.
Other care that's ending
| Care | Notice | Deadline to call Acentra Health |
|---|---|---|
| Hospital inpatient stay | Important Message from Medicare | By your planned discharge day |
| Skilled nursing, home health, hospice or outpatient rehabilitation (CORF) | Notice of Medicare Non-Coverage, at least 2 days before services end | By noon the day before the end date on the notice |
If you were admitted and then changed to "outpatient getting observation services," you can still ask for a fast appeal while you're in the hospital. A notice from a nursing home or adult care home telling a resident to move out is a different matter: North Carolina residents appeal it to the NC Medicaid Hearing Office (919-814-0090).
Related questions
How do I appeal a Medicare denial in North Carolina?
Claims and plan denials.
How can I help a parent with Medicare?
Speaking up for a parent.
Medicare phone numbers in North Carolina
Official numbers.
More in Medicare appeals in North Carolina and North Carolina Medicare contacts.
Sources
- Medicare.gov — Fast appeals (hospital discharge and services ending)
- Acentra Health BFCC-QIO — How to file an appeal
- CMS — Beneficiary and Family Centered Care QIOs
- NC Medicaid — Appeals (Hearing Office)
More questions in this guide
- How can I help a parent with Medicare in North Carolina?
- How do I appeal a Medicare denial in North Carolina?
- How do I file a complaint about an insurance agent in North Carolina?
- How do I find a licensed Medicare agent in North Carolina?
- How do I find my area agency on aging in North Carolina?
- How do I report Medicare fraud in North Carolina?
- Medicare phone numbers in North Carolina
Part of the guide: North Carolina Medicare contacts · All questions
Frequently asked questions
Do I pay for the extra days while the appeal is reviewed?
Medicare.gov says that if you ask on time, you can stay in the hospital while you wait and won't pay for the stay, except usual coinsurance or deductibles. If Acentra Health agrees you're ready, you're covered through noon of the day after its decision.
Does this work with a Medicare Advantage plan?
Yes. People in Original Medicare and in Medicare Advantage plans, including State Health Plan retirees in the Base or Enhanced Plan, get the Important Message from Medicare and can ask Acentra Health for a fast appeal of a hospital discharge.
What if I miss the deadline?
You can still ask Acentra Health to review your case, but different rules and time frames apply, and you might have to pay for hospital days after the original discharge date.
What about skilled nursing or home health ending?
You'll get a Notice of Medicare Non-Coverage at least 2 days before covered skilled nursing, home health, hospice or outpatient rehabilitation services end. Call Acentra Health by noon of the day before the end date on the notice.
Medicare in your North Carolina county
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