A discharge notice starts a clock measured in hours. On that appeal, the burden of proof is not yours.
Medicare has several appeal systems and they run on very different clocks. The fast route when care is ending, the five level chain when a bill is refused, the Advantage step that happens without being asked for, and the route that exists after a deadline has gone.
Updated September 2026, 30 minute read
What changed: 2026-09-05: First published.
Contents (9 sections)
- 1.A discharge notice starts a clock measured in hours. On that appeal, the burden of proof is not yours.
- 2.Which system you are in, and how to tell within a minute
- 3.When home health, nursing or hospice care is being ended Members only
- 4.When a hospital says the stay is over Members only
- 5.The five levels when a claim has been refused Members only
- 6.An Advantage plan is a different machine, and one step happens on its own Members only
- 7.When the deadline has gone, and the rule about new evidence Members only
- 8.The one afternoon checklist Members only
- 9.Where these rules come from Members only
Section 1 of 9, about 28 minutes left
Part 1. A discharge notice starts a clock measured in hours. On that appeal, the burden of proof is not yours.
There is no single Medicare appeal. There are several, they run on very different clocks, and the one that applies is fixed by two facts about the situation rather than by anything to do with the merits.
The first fact is whether the coverage is Original Medicare or a Medicare Advantage plan. Those are separate machines with separate rules.
The second is whether care is ending now or a bill has already been refused. Care ending now routes into a fast track measured in hours, where an independent reviewer decides within three days. A refused bill routes into an ordinary chain of five levels measured in months.
The single most useful fact in this guide belongs to the fast track. Federal regulations place the burden of proof on the provider to show that ending coverage is the correct decision. The person appealing is not required to prove they still need care; the hospital or agency is required to prove they do not.
These rules are federal and apply the same way in every state, though the independent review organizations that decide fast appeals are assigned by area. State law governs a hospital's other obligations and is not covered here.
This guide is educational information. It is not legal, tax or financial advice, and it does not say whether any particular decision is worth appealing.
Part 2. Which system you are in, and how to tell within a minute
Before anything else, two questions.
| Situation | Route | Deadline to start |
|---|---|---|
| Home health, nursing facility, rehabilitation or hospice care is being ended | Fast appeal to the independent review organization | Noon of the day after receiving the notice |
| A hospital says an inpatient stay is over | Fast appeal to the same organization | The day of discharge |
| Original Medicare has refused to pay a claim | The five level chain | 120 days from receipt of the notice |
| An Advantage plan has refused a service or a payment | The plan's own process, then an automatic step | 60 days from receipt of the plan's written decision |
The fast routes are the ones with hours rather than months attached, and they are the ones people miss, because the notice announcing them arrives during a hospital stay or on the day someone is being sent home.
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- When home health, nursing or hospice care is being ended
- When a hospital says the stay is over
- The five levels when a claim has been refused
- An Advantage plan is a different machine, and one step happens on its own
- When the deadline has gone, and the rule about new evidence
- The one afternoon checklist
- Where these rules come from
About 26 minutes of reading left.
Part 3. When home health, nursing or hospice care is being ended Members only
Two days of notice, a deadline at noon the next day, a decision within seventy two hours, and no bill in the meantime.
Part 4. When a hospital says the stay is over Members only
The notice arrives at admission, days before it matters. The appeal has to be started by the day of discharge, and doing so freezes the bill.
Part 5. The five levels when a claim has been refused Members only
Each level has its own deadline, and three of them are different lengths. Nothing moves to the next level on its own.
Part 6. An Advantage plan is a different machine, and one step happens on its own Members only
The deadlines are shorter, the request can be made by telephone, and the step readers most often miss is the one they do not have to take.
Part 7. When the deadline has gone, and the rule about new evidence Members only
A missed deadline is not always the end, and one very common kind of denial is not supposed to be appealed at all.
Part 8. The one afternoon checklist Members only
Twelve things, with the hour-long deadlines first.
Part 9. Where these rules come from Members only
The Medicare appeal regulations, section by section.