Your state's Medicare QIO (fast appeals: Acentra Health or Commence Health)
If a hospital says you must leave, or a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility or hospice says Medicare is ending your care, and you disagree, you can ask your state's Medicare QIO (Quality Improvement Organization) for a fast appeal. It is an independent reviewer. It also takes concerns about the quality of care you got for a Medicare-covered service.
Good to know
Two companies run the QIO program, Acentra Health and Commence Health, each for a group of states. The notice your hospital or provider gives you (the Important Message from Medicare, or the Notice of Medicare Non-Coverage) carries your state's QIO name and toll-free number, and the CMS region map linked from this page lists the number for each region. CMS says QIO services are at no cost to eligible people with Medicare. Medicare.gov says to follow the directions on the Important Message no later than the day you are scheduled to be discharged; for other providers, no later than noon the day before the date on your Notice of Medicare Non-Coverage. CMS's Medicare Claims Processing Manual says the QIO must be available to receive requests for review 24 hours a day, 7 days a week.
Before you call
Have ready
- the Important Message from Medicare, or the Notice of Medicare Non-Coverage, with the QIO's name and toll-free number on it
- a way to be reached: 42 CFR 405.1206 says that when the QIO asks, you or your representative must be available to discuss the case
They may ask
- why you think coverage should continue
They can
- look at your medical records and the information the hospital or provider gave it, and decide whether your covered services should continue
- let you ask for copies of the materials that were sent to it: Medicare.gov says you can
- protect you from the hospital bill while it decides: if you ask in time, you do not pay for the extra days up to noon the day after it decides, apart from your usual coinsurance or deductible
They cannot
- promise to stop a hospital discharge: one of the two Medicare reviewers reports that in most hospital-discharge appeals it agrees with the hospital, and that appeals about care ending in a nursing facility, at home, in hospice or in outpatient rehab go the patient's way about half the time. So ask, and at the same time plan for the care ending
- be reached on one national number: the number for your state is on your notice, and the CMS region map lists them
In the emergency guides: I'm being sent home from hospital, or someone I care for is →
- Website
- https://www.cms.gov/medicare/quality/quality-improvement-organizations/family-centered-care
- Coverage
- Nationwide (U.S.)
- Languages
- English
- Best for
- Older adults
- Last checked
- October 10, 2026
See something out of date or wrong? Tell us by email.
Shared by FindAngel.org — free, always · https://findangel.org/resources/us-bfcc-qio/