If you are receiving care in a hospital or non-hospital setting and you learn that your care is going to end, you have the right to a fast, or expedited, appeal to request continued care. Non-hospital facilities include Skilled Nursing Facilities (SNFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), hospice settings, and home health agencies. Note that hospital and non-hospital settings can overlap. For example, a hospital building may also include a skilled nursing facility. Although they are in the same building, the type of care they provide is different. The distinction between hospital and non-hospital settings is made in these materials because there are different steps in the appeal process depending on whether a hospital or non-hospital care is ending. In both cases, you can file an appeal to challenge your provider’s decision to end your care if you think that they are wrong about whether Medicare will cover your services. If you are unable to appeal, a family member or other representative can appeal for you. If your appeal is unsuccessful at the first level, you can continue to appeal by following instructions on the denial notices you receive.
Expedited appeals have tight deadlines, so it is important to pay attention to the timeframes for appealing at each level. Keep copies of any appeal paperwork you send out, and if you speak to someone on the phone, get their name and write down the date and time that you spoke to them. It is helpful to have all of your appeal documents together in case you run into any problems and need to access documents you already mailed.
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