When a parent’s care is ending: the fast appeal.

Before covered services end, the provider must give your parent a Notice of Medicare Non-Coverage, at least two days ahead. It gives the date coverage ends and explains how to ask for a fast appeal. If you didn’t get one, ask the provider for it.

Your parent, or you as their representative, signs it to show it was received and understood. Medicare.gov lists hospice care as well. Hospital discharges use a different notice, the Important Message from Medicare, with their own rules.

Follow the instructions on the notice no later than noon the day before the end date it lists. You can ask by phone or in writing.

The appeal goes to an independent reviewer called the Beneficiary and Family Centered Care Quality Improvement Organization, or BFCC-QIO. Depending on the state, it is run by Commence or Acentra. The notice tells you which one and how to reach them.

The reviewer tells the provider, and by the end of that day your parent gets a Detailed Explanation of Non-Coverage: why the services are ending, the coverage rule the plan relied on, and how it applies to them.

The reviewer asks why you think the care should continue and looks at the medical records. The plan has to prove that ending coverage is right, not the other way round. The decision comes by close of business the day after the reviewer has the information it needs.

Coverage continues until the date and time on the notice unless the reviewer reverses the plan. If the reviewer agrees the care should end, your parent isn’t charged for services before the end date on the notice, but may have to pay for services after it.

• Missed the deadline: you can ask the plan for a fast reconsideration instead, but the services are only covered if the decision goes your way.
• The reviewer agrees with the plan: you can ask it to reconsider within 60 days of being told. It has 14 days to answer.