How to File an Appeal

Hospital Discharge Appeals

If you have Medicare (including Medicare Advantage), you have the right to appeal a hospital discharge if you feel too sick to leave. The hospital will give you a form called "An Important Message from Medicare." This form tells you how to appeal the discharge.

If you call Acentra Health for an appeal, Acentra Health’s doctor will look at the medical record to see if you should stay in the hospital.

During the appeal,

• You do not have to leave the hospital.
• You do not have to pay for the extra days in the hospital while Acentra Health reviews the medical record.

Skilled Service Termination Appeals

If you have Medicare (including Medicare Advantage), you have the right to appeal a discharge if you do not agree with the decision that Medicare skilled services will be stopped. You must be given a letter called a Notice of Medicare Non-coverage with the planned discharge date explaining how to appeal.

Once you receive the letter, you can call Acentra Health. Acentra Health’s doctor will look at the medical record to see if the services should continue.

Read more about appeals: Medicare Appeals, the official government booklet from Medicare (PDF)

Hospital Observation Appeals

If you have Original Medicare (not a Medicare Advantage Plan), you have the right to appeal if a hospital changes your status from inpatient to outpatient under observation. This change matters because it can affect how much you pay and whether Medicare will cover care in a skilled nursing facility after you leave the hospital.

You should get a notice from the hospital called a Medicare Change of Status Notice (MCSN). This notice explains the change and your right to ask for a review. Once you get this notice, you can call us right away. Acentra Health will have a doctor review your medical records to see if you should have been listed as an inpatient. This service is free and part of your Medicare rights.

Immediate Advocacy Discharge Assistance

This process applies only to Medicare patients with Original (Fee-for-Service) Medicare who call Acentra Health regarding a hospital discharge appeal.

Worried About Leaving the Hospital Too Soon?

Have you or someone you care for been told you are leaving the hospital soon, but you don’t feel ready? This can be confusing and stressful. Help is available.

Immediate Advocacy Discharge Assistance helps with concerns about leaving the hospital. This service is for people who:

• Have Original Medicare
• Are staying in an acute care hospital
• Have been told that a discharge is planned

Immediate Advocacy Discharge Assistance can:

• Explain your discharge plan in simple, clear words
• Help you talk with hospital staff and case managers
• Make sure your questions and concerns are shared and understood

This service gives you extra support during a difficult time.

Immediate Advocacy Discharge Assistance does not take away your right to appeal a discharge and does not change appeal deadlines. It is meant to help you understand what is happening, not replace the appeal process.

Immediate Advocacy Discharge Assistance works with the hospital to help with communication. However, they cannot look at medical records, decide if care is medically needed, or promise to change the discharge date. The goal is to help you understand what is happening, know your choices, and feel supported during the discharge process.

You or someone helping you can contact Acentra Health to ask for Immediate Advocacy Discharge Assistance.

• Contact information is on hospital discharge notices
• You can call our Helpline.

Leaving the hospital can feel overwhelming, especially if you don’t feel ready. Immediate Advocacy Discharge Assistance is here to listen, answer your questions, and help make sure your concerns are heard.

Denial of Coverage from a Medicare Advantage Plan

If you have a Medicare Advantage plan, you have some additional Medicare rights. If you are concerned that you cannot get the care you need, you have the right to appeal to the Medicare Advantage plan. You can appeal things like denials for:

• Referrals to a specialist;
• Approval for tests (like x-rays or blood tests); and
• Payment of a bill.

The Medicare Advantage plan has information about how to start the appeal process. If you feel you may get worse by waiting too long, you can ask for an expedited appeal. This means the Medicare Advantage plan must make a decision about the appeal within three calendar days. If you need this faster review, ask your Medicare Advantage plan for an “expedited appeal.”

For additional information about a denial of coverage, call 1-800-MEDICARE.

For additional information about asking for medical records, please complete a Medical Record Request.