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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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hospital appeals

If you have Medicare, you have the right to appeal a hospital discharge if you feel too sick to leave, even if you have a Medicare Advantage plan. The hospital will provide "An Important Message from Medicare," which explains how to appeal the discharge. 

If you call KEPRO for an appeal, KEPRO’s physician will look at the medical record to see if you should stay in the hospital. Then you will be informed of the decision. 

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 services appeals

If you have Medicare, 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, even if you have a Medicare Advantage plan. 

Once you receive the letter, you can call KEPRO. KEPRO’s physician will look at the medical record to see if the services should continue, and then you will be informed of the decision.

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.

kepro contact information

KEPRO Region 1 – Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

Appeal Helpline - 888-319-8452

KEPRO Region 4 – Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

Appeal Helpline - 888-317-0751

KEPRO Region 6 – Arkansas, Louisiana, New Mexico, Oklahoma, Texas

Appeal Helpline - 888-315-0636

KEPRO Region 8 – Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

Appeal Helpline - 888-317-0891

KEPRO Region 10 – Alaska, Idaho, Oregon, Washington

Appeal Helpline - 888-305-6759

TTY* for all areas: 855-843-4776 

*A TTY (teletypewriter) is a special device that lets people who are deaf, hard of hearing, or speech-impaired use the telephone to communicate, by allowing them to type messages back and forth to one another instead of talking and listening. A TTY is required at both ends of the conversation in order to communicate.

For additional information about asking for medical records, please complete a Medical Record Request Form.

 


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