By Cleveland Senior Advisor Care Team · September 14, 2026
When a hospital or a rehab unit tells you Medicare coverage is ending, that is a decision you can appeal, for free, in about ten minutes. Ohio families call one number. Most never learn it exists.
The sentence that sounds like a medical fact and is not
It usually arrives on a weekday afternoon, from someone pleasant who is not a doctor. Medicare is going to stop covering your mother's rehab stay on Friday. Here is a paper to sign. Have you thought about where she is going?
Families hear that as a clinical finding, the way they would hear a lab result. It is not. It is a coverage determination made by the facility, and federal law gives your mother the right to have an independent reviewer look at it before she has to leave, at no cost, on a timeline measured in a day or two.
The reason so few Cleveland families use that right is not that it is hard. It is that the deadline runs out before anyone realizes a deadline exists. The notice explaining it is handed over in a folder alongside a dozen other pages, at the exact moment a family is least able to read carefully.
This is a different problem from the one we wrote about in observation status. That one is about whether Medicare will pay for rehab at all. This one is about care Medicare has already been paying for, and a facility saying the payment stops now.
Two notices, two very different deadlines
Which notice your family gets depends on where your parent is sitting, and the deadlines are not the same. Getting this backwards is the single most common way the right is lost.
In a hospital, the notice is called An Important Message from Medicare about Your Rights, usually shortened to the IM. Under Medicare's own rules, your parent should get it within two days of admission as an inpatient, and again before discharge. If the hospital delivered the IM more than two days before the discharge day, it must hand over a copy of the original signed notice or issue a new one to sign. To appeal, you follow the instructions on the IM no later than the day your parent is scheduled to be discharged.
In a skilled nursing facility, a home health agency, a comprehensive outpatient rehabilitation facility or hospice, the notice is different. It is a Notice of Medicare Non-Coverage, and it should arrive at least two days before covered services end. Here the deadline is tighter than people assume: no later than noon the day before the termination date printed on the notice.
So if the paper says coverage ends Friday, the call happens by noon Thursday. Not Friday morning. Not when the family meets over the weekend. Noon Thursday.
If you did not get a notice, ask for one. It is not optional paperwork the facility may skip, and a family that was never given the IM has not thereby lost anything — but you cannot act on instructions you have not read.
The one phone number an Ohio family needs
The independent reviewer is called a Beneficiary and Family Centered Care Quality Improvement Organization, a name so unhelpful that everyone shortens it to BFCC-QIO. The country is split into regions, and each region has one.
Ohio sits in Region 5, together with Indiana, Illinois, Michigan, Minnesota and Wisconsin. The contractor is Livanta, which now operates under the name Commence Health. The number for our region, published on its CMS-hosted site, is 1-888-524-9900.
Expect to see both names in circulation for a while yet. The organization was renamed in 2025, and a good deal of printed material, including notices sitting in hospital folders across Northeast Ohio, still says Livanta. If a staff member tells you Livanta no longer exists, they are half right and entirely unhelpful. It is the same contractor.
It is worth being clear about what this number is not. It is not the long-term care ombudsman, who for Cuyahoga, Geauga, Lake, Lorain and Medina counties is Region 10A in Cleveland at 1-800-365-3112, and who handles resident rights and quality-of-care problems rather than Medicare coverage decisions. It is not the Ohio Department of Health complaint line. Those offices do real work, and they are the right call for other problems, but none of them can stop a discharge clock. If your parent lives in Summit or Portage County, note that the ombudsman boundary shifts to a different regional office — the QIO number, however, is the same statewide.
What the next two days actually look like
Once you file, the review organization notifies the facility, and a second document is triggered. In a hospital, by noon the day after the QIO gives notice, you should receive a Detailed Notice of Discharge. In a skilled nursing facility or home health setting, by the end of the day the provider receives notice, you should get a Detailed Explanation of Non-Coverage.
Read that second document closely, because it is the one with the actual argument in it. It must say why the services are no longer considered reasonable and necessary or no longer covered, identify the Medicare coverage rule or policy being applied, tell you how to obtain a copy of that policy, and explain how the rule applies to your parent specifically. Anything vaguer than that is not what the rule requires.
The reviewer then asks why you believe coverage should continue, reads the medical record and whatever the facility submitted, and decides. In the hospital setting, the decision comes within one day of the reviewer receiving the information it asked for. In the other settings, by close of business the day after.
You are also entitled to copies of everything the facility sent the reviewer. Ask for it in the same call. Families are frequently surprised by what the chart says about their parent's progress, and that surprise is more useful before the decision than after it.
What it costs you to be wrong
This is the part that changes behavior once families understand it, because the downside is smaller and far more bounded than it feels at two in the afternoon with a social worker waiting.
In the hospital, if you filed on time and the reviewer sides with the hospital, your parent is not responsible for the hospital charges through noon of the day after the decision is delivered, apart from the coinsurance or deductibles that would have applied anyway. Services after that point can be billed to her. Miss the deadline and file late and different rules apply, and the stay past the original discharge date may land on her.
In a skilled nursing facility or home health agency, losing the appeal means she is not responsible for covered services provided before the coverage end date printed on the Notice of Medicare Non-Coverage. Services after that date can be charged to her.
It also helps to know what the coverage you are fighting for is worth. Medicare's skilled nursing benefit carries no daily coinsurance for the first twenty days of a benefit period. From the twenty-first through the hundredth day, the beneficiary owes a daily coinsurance that CMS set at $217 for 2026, up from $209.50 the year before. A supplemental policy may cover it. Private-pay rehab, once coverage genuinely ends, costs considerably more than that per day, which is why the difference between day 19 and day 21 matters so much to a household budget.
We are not going to tell you what share of these appeals succeed. Overturn rates get quoted confidently online and we could not trace a current Ohio-specific figure to a source we would stand behind, so we will not invent one.
The argument that wins more often than families expect
If you take one thing from this page, take this. The most common reason a family is given — she has plateaued, she is not making progress anymore, she has reached her maximum potential — is not, standing alone, a lawful basis for ending Medicare coverage of skilled care.
That misunderstanding had a name, the improvement standard, and it was the subject of a class action, Jimmo v. Sebelius, settled in 2013. Under the settlement, CMS revised its own program manuals to confirm that coverage of skilled nursing and skilled therapy services does not turn on whether the patient has potential to improve. It turns on whether the patient needs skilled care.
Skilled care may be needed to improve someone's condition. It may equally be needed to maintain the condition she is in, or to slow or prevent her decline. All three are coverable. The standard reaches skilled nursing facility care, home health and outpatient therapy.
This matters enormously for the population we work with in Greater Cleveland, because a great many people with Parkinson's, advanced dementia, ALS or multiple sclerosis are never going to improve, and were never expected to. If the documented reason for ending coverage is a lack of progress rather than a finding that skilled care is no longer needed, say so plainly to the reviewer, and name the Jimmo settlement when you do. Facility staff sometimes repeat the old standard in good faith because it is what they were taught.
What to do in the hour after the notice lands
Find the termination date on the notice and write it down, along with the deadline that flows from it. Everything else depends on that date being right, and it is occasionally wrong.
Call the number on the notice, or 1-888-524-9900, and say you want to file a fast appeal. You do not need a lawyer, a form, or a medical argument prepared in advance. Your parent, or you on her behalf, can start it on the phone.
Then ask the therapy staff a direct question: what specifically changed in her condition that makes skilled care no longer necessary? Write down the answer. If the answer is about progress rather than need, you have just been handed the substance of your appeal.
And build the next step in parallel, because this is the honest limit of what a fast appeal does. Winning buys days, sometimes a couple of weeks. It does not solve what happens after rehab. Families who use the appeal and simultaneously start the conversation about long-term arrangements do better than families who treat the appeal as the plan. If the answer after this is going to involve Medicaid, the timing is unforgiving and worth understanding now rather than later.
If you are already past the point where days matter, our guides on a discharge date you did not choose and on how Ohio families actually pay for care cover the ground this page does not. The fast appeal is a lever, not an answer. It is just a lever almost nobody in Northeast Ohio knows is there, and it is free to pull.
