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3 generations of women smiling How to File an Appeal
We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!

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watch a video about appeals:

How to File an Appeal

contact information

To speak with a representative about Kepro's services, click on the link below for the phone number for your state.

Kepro Telephone Numbers

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 Kepro for an appeal, Kepro’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 Kepro 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 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 Kepro. Kepro’s doctor will look at the medical record to see if the services should continue.

beneficiary care management program (bcmp)

Effective February 1, 2022, the Beneficiary Care Management Program (BCMP) is no longer accepting new referrals for care management services. Beneficiaries are encouraged to continue working with their respective regional Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO) for assistance. For more information please visit https://qioprogram.org/locate-your-qio  on how to locate the BFCC-QIO that services your area. Thank you.

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 Form.

 


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