If you received Form CMS-10123, the Notice of Medicare Non-Coverage (NOMNC), you can appeal by calling the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) listed on the form no later than noon on the calendar day before the coverage end date printed on the notice. File on time and your skilled nursing, home health, hospice, or outpatient rehab services keep running at no extra cost while an independent reviewer decides, usually within 72 hours.1Medicare.gov. Fast Appeals
What the Notice Is Telling You
The NOMNC is the standard form providers must hand you when Medicare-covered services are about to end in four settings: skilled nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities, and hospice.2Centers for Medicare and Medicaid Services (CMS). Notice Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS-10123 It lists the exact date coverage will stop and the phone number for the BFCC-QIO that handles fast appeals in your state.
You or your representative sign and date the form to confirm you received it. If you refuse to sign, the provider records the date of refusal, and that date counts as your official receipt for the appeal clock. The provider must deliver the notice at least two calendar days before your last covered day, so if coverage is scheduled to end Friday, the NOMNC should reach you by Wednesday.3Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual – Transmittal 2711 – Section: 260.3.3 Provider Delivery of the NOMNC
Hospital inpatient discharges are a different process. Hospitals use the Important Message from Medicare, with its own timeline, so nothing in this article applies to a hospital discharge you disagree with.4CMS. FFS and MA NOMNC/DENC
The Deadline: Noon the Day Before Coverage Ends
You have to reach the BFCC-QIO by noon on the calendar day before the termination date printed on your NOMNC.1Medicare.gov. Fast Appeals If the notice says coverage ends Thursday, you file by noon Wednesday. Meeting that deadline is what triggers two protections: your provider must keep delivering services during the review, and you owe nothing beyond your usual coinsurance or deductibles for that care.
How to File
The appeal goes to the BFCC-QIO, not to your provider and not to Medicare. The toll-free number is printed on the NOMNC itself. You can also file online through the BFCC-QIO’s website, which time-stamps the submission as the legal start of your appeal.5Commence Health BFCC-QIO. Appeal Initiation
If a family member, caregiver, or advocate is going to handle the appeal for you, Medicare allows you to appoint that person using CMS Form 1696, the Appointment of Representative.
What Happens After You File
The BFCC-QIO notifies your provider once your appeal is in. The provider then has until close of business that same day to give you a second document, the Detailed Explanation of Non-Coverage (DENC), which spells out why services are being terminated and identifies the specific Medicare coverage rule being applied.6Centers for Medicare and Medicaid Services (CMS). Notice Instructions for the Detailed Explanation of Non-Coverage (DENC)
The reviewer then examines your medical records alongside the provider’s reasoning. You can ask for copies of anything your provider sends to the reviewer.1Medicare.gov. Fast Appeals The BFCC-QIO must issue a decision within 72 hours of receiving your appeal and the necessary medical information.7eCFR. 42 CFR Part 405 Subpart J – Section: 405.1202 Expedited Determination Procedures If the reviewer agrees with you, Medicare coverage continues as long as your care is medically necessary. If the reviewer sides with the provider, you move into the financial liability rules described below.
Evidence That Strengthens Your Case
The BFCC-QIO is making a medical necessity decision, so clinical evidence is what matters. Pull together recent physician notes, therapy progress records, lab results, and any documentation showing that stopping services would cause your condition to deteriorate.
A statement from your treating physician is the single most useful piece of evidence you can submit. Medicare’s own guidance directs beneficiaries to ask their doctor for information to give the BFCC-QIO.8CENTERS for MEDICARE & MEDICAID SERVICES. Medicare Appeals A letter explaining why you still need skilled care, whether for improvement, maintenance, or preventing decline, gives the reviewer a clinical counterpoint to the termination. Send it in as soon as you can; the 72-hour clock is already running.
Who Pays During and After the Review
If you filed on time, services continue at no extra cost during the review beyond your normal coinsurance and deductibles. If the reviewer ultimately upholds the termination, you are not responsible for the cost of services received before the termination date on the NOMNC.8CENTERS for MEDICARE & MEDICAID SERVICES. Medicare Appeals Care you receive after that date may be your own out-of-pocket cost.
If you filed late, you lose that financial shield. The BFCC-QIO will still review your case, but the 72-hour timeframe no longer applies, and you may owe for services received while you wait for a decision.7eCFR. 42 CFR Part 405 Subpart J – Section: 405.1202 Expedited Determination Procedures
If You Missed the Noon Deadline
A missed deadline does not end your appeal rights. Contact the BFCC-QIO anyway; the office will accept a late request and decide as soon as it can.8CENTERS for MEDICARE & MEDICAID SERVICES. Medicare Appeals You just lose the guaranteed 72-hour turnaround and the protection from paying during the review.
If the BFCC-QIO Denies Your Appeal
The fast appeal is the first of five levels. Most cases resolve at the first or second, but the higher levels are there when the dollar amounts are significant or you believe the denial reflects a broader error.
Level 2: Reconsideration by a Qualified Independent Contractor
You have 180 calendar days from receipt of the BFCC-QIO’s decision to request reconsideration by a Qualified Independent Contractor (QIC). Receipt is presumed to be five days after the notice date unless you show otherwise. The QIC conducts an independent, on-the-record review of all the evidence, including anything new you submit, and you can request a good-cause extension if you missed the window.9eCFR. 42 CFR Part 405 Subpart I – Reconsideration
Level 3: Administrative Law Judge Hearing
If the QIC denies you too, you can request a hearing before an Administrative Law Judge at the Office of Medicare Hearings and Appeals within 60 days of receiving the QIC decision. The amount remaining in dispute must be at least $200 for 2026.10Federal Register. Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2026 You can file by mail or through the OMHA e-Appeal Portal.11CMS. Decision by Office of Medicare Hearings and Appeals (OMHA)
Level 4: Medicare Appeals Council
If the ALJ rules against you, you have 60 days from receipt of that decision to request review by the Medicare Appeals Council. The request must be in writing, identify which parts of the ALJ’s decision you disagree with, and explain why.12eCFR. 42 CFR Part 405 Subpart I – Medicare Appeals Council Review
Level 5: Federal Court
The final step is a lawsuit in federal district court. The amount in controversy must be at least $1,960 for 2026.10Federal Register. Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2026