Important Message from Medicare (IM): what it means and what to do

Given at hospital admission and again near discharge; explains your right to appeal a discharge.

An Important Message from Medicare is given at hospital admission, and again near discharge — it explains your right to appeal the discharge decision itself, not just what happens after you leave.

Like the NOMNC, this notice comes with a same-day fast-appeal option through the QIO, an outside reviewer independent of the hospital.rule42 CFR 422.622

This notice is given twice for the same hospital stay: once at admission, as a general statement of appeal rights, and again close to the planned discharge date, with the actual date on it. The fast-appeal deadline runs from that second, discharge-specific notice — not the one you signed on the way in.

Disagreeing with a discharge date doesn't mean disputing that discharge will eventually happen — it means asking an outside reviewer whether today is too soon, based on the patient's actual condition.

The hospital and the QIO are two different parties in this — the hospital made the discharge decision, but it's the QIO, an outside reviewer under contract with CMS, that decides whether that decision holds up, not the hospital reconsidering its own call.

The hospital has to provide a detailed explanation of the discharge decision once the QIO asks for it — you don't have to gather that yourself. That explanation, once you have it, is often the clearest picture you'll get of the hospital's actual reasoning.

Call the QIO before you leave the hospital. Say you want to file a fast appeal (expedited determination) of a hospital discharge decision. Give the QIO the planned discharge date from the Important Message. Ask them to request the detailed notice from the hospital on your behalf.

Note the deadline. Request review no later than the day of discharge, before you leave the hospital.

Know what happens next. The QIO decides by close of business the day after it has all the information it needs. The hospital must send a detailed notice explaining the discharge decision.

You can still appeal through the standard reconsideration process within 65 days of the notice.