Appeals of Notices of Medicare Noncoverage

QIOs, under their contracts with the Centers for Medicare & Medicaid Services (CMS), help protect the rights of people with Medicare to receive medically necessary care that is covered by Medicare.

Medicare beneficiaries and their representatives have the right to a fast appeal with the Northeast Health Care Quality Foundation when a health care provider notifies them that Medicare covered services will be ended or that a hospital admission will not be covered by Medicare.

If you disagree with the Noncoverage Decision and want to request an appeal:

The health care provider is required to give you a written notice of Medicare noncoverage that explains appeal rights.

If you receive a notice about noncovered services provided in Maine, New Hampshire or Vermont and you disagree with the notice, you should call the Northeast Health Care Quality Foundation at 1-800-772-0151 (or 1-877-486-2048 TTY/TDD).

The notice will explain the timeframe for requesting a fast appeal. If you miss the timeframe, you should call the Northeast Health Care Quality Foundation to find out if you have other appeal rights.

An appeal to the Northeast Health Care Quality Foundation can be made in the following situations:

• Care is or was being provided in Maine, New Hampshire or Vermont.
• You are told that the hospital admission will not be covered by Medicare.
• You are told that the Medicare beneficiary is ready for discharge from a hospital or that Medicare will not cover a longer stay in the hospital.
• You are told that skilled services are being ended by a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility or hospice.