Short answer: Call the BFCC-QIO listed on the “Important Message from Medicare about Your Rights” no later than the day of the planned discharge; if the request is on time, the patient can stay while the QIO decides and is not billed for the extra days (beyond normal deductibles and coinsurance) until noon of the day after the decision.
Hospitals must give the Important Message from Medicare (IM) within 2 days of admission and again before discharge if it was given more than 2 days earlier. The QIO notifies the hospital, which must then give a Detailed Notice of Discharge explaining why. The hospital carries the burden of proving discharge is correct. The QIO decides within one day of getting the information it needs.
If the QIO agrees with the patient, Medicare keeps covering the stay as long as medically necessary. If it agrees with the hospital, the patient is protected through noon of the day after the decision.
Missing the deadline is not the end: the patient can still ask the QIO for review during the stay, or within 30 days after discharge, but without the financial protection. Medicare Advantage members use the same QIO process for hospital discharges, though coverage of continued days depends on the plan having authorized the admission or it being emergency care.