Short answer: Follow the “Notice of Medicare Non-Coverage,” which must arrive at least 2 days before services end, and ask the BFCC-QIO for a fast appeal no later than noon the day before the termination date.
The fast appeal applies to skilled nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities and hospice. Once the QIO is contacted, the provider must give a Detailed Explanation of Non-Coverage by the end of that day, and the QIO decides by close of business the day after it gets what it needs.
If the QIO agrees services are ending too soon, Medicare may keep covering them (subject to normal cost sharing). If not, the person is not charged for services before the end date on the notice but may owe for services after it.
A Medicare Advantage member who misses the QIO deadline can request a fast reconsideration from the plan, but services are covered only if the decision goes in the member’s favor.