How to Appeal a Hospital Discharge in Texas: Medicare QIO Process Step by Step

Your parent's discharge planner just handed you a stack of papers and said they are being sent home — or to a facility you have never visited — tomorrow morning. The doctor says they are medically stable, but you know they cannot manage alone. You have until midnight tonight to file an appeal that keeps them in the hospital at Medicare's expense.

Here is exactly how to do it.

The Two Notices That Trigger an Appeal

Medicare requires hospitals to issue specific notices before ending coverage. The type of notice determines which appeal path you use.

Important Message from Medicare (IM): Issued during an inpatient stay, this notice informs the patient of their right to appeal before discharge. You must receive it twice — once within two calendar days of admission and a second copy within two calendar days of the planned discharge date; the follow-up copy must be signed and dated.

Notice of Medicare Non-Coverage (NOMNC): Used when Medicare-covered services at a SNF or home health agency are ending. Follow the appeal deadline and instructions printed on the notice.

Both notices include the phone number for Acentra Health, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) responsible for Medicare appeals in Texas.

Step-by-Step: Filing the Expedited Appeal

Step 1 — Call Acentra Health immediately. Toll-free: 1-888-315-0636. Call as soon as possible. You do not need to be the patient — any family member or representative can file.

Step 2 — State that you are requesting an expedited review of a hospital discharge or service termination. Be specific: give the patient's name, Medicare number, hospital name, and the date the hospital intends to discharge.

Step 3 — Meet the midnight deadline. For an IM appeal (hospital discharge), you must contact Acentra Health before midnight on the day the hospital plans to discharge your parent. If you miss this deadline, the patient becomes financially responsible for hospital charges starting at noon the next day.

For a NOMNC appeal (end of SNF or home health services), follow the deadline printed on the notice.

Step 4 — The hospital responds. Once you file, the hospital must deliver a Detailed Notice of Discharge (DND) by noon the following day. This document must state the specific clinical reasons why inpatient care is no longer medically necessary.

Step 5 — Acentra Health reviews. The QIO reviews the hospital's medical records, the DND, and any information you provide. They must issue a decision within one full calendar day of receiving all necessary documentation.

Step 6 — Read the outcome. If Acentra Health agrees with the hospital, coverage ends at noon the day after you receive the decision. If Acentra Health overturns the discharge, Medicare continues to cover the stay and the hospital must continue providing care.

What Happens During the Review

While the appeal is pending, your parent stays in the hospital and Medicare continues to pay. The hospital cannot discharge the patient, and no additional charges can be billed to the patient or family during this period. This protection only applies if you filed before the midnight deadline.

If the First Appeal Fails

You can escalate. Ask Acentra Health or Medicare about the applicable reconsideration process and deadline for your case. This second-level review is conducted by an independent entity that re-examines the medical evidence.

Common Mistakes That Kill the Appeal

Missing the midnight deadline. This is the most common failure. Discharge planners sometimes deliver the IM late in the day, leaving families only hours to act. If you suspect a discharge is coming, obtain the IM and confirm the scheduled discharge date promptly so you can contact Acentra Health before the deadline.

Not providing your own documentation. The QIO reviews the hospital's records by default. If your parent has complications the hospital is downplaying — falls, confusion, inability to manage medications — write them down and submit them to Acentra Health during the review window.

Assuming you need a lawyer. You do not need legal representation to file a QIO appeal. The process is designed for patients and families to use directly.

Beyond the Hospital: SNF and Home Health Appeals

The NOMNC process applies when a skilled nursing facility says Medicare coverage is ending because your parent has "plateaued" in therapy, or when a home health agency terminates services. The deadline and review protections depend on the notice and service type; follow the instructions and contact Acentra Health promptly.

The Hospital-to-Home Texas toolkit includes pre-written appeal scripts, a timeline worksheet for tracking every deadline, and a medication reconciliation form — designed for families handling this without professional help.

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