By Austin Senior Advisor Care Team · July 27, 2026
Medicare gives every inpatient the right to a free, one-day appeal of a hospital discharge, and almost nobody uses it. Here is the deadline, the Texas phone number, and the choice the case manager is required to offer you.
The notice your parent already signed
Within two days of an inpatient admission, the hospital hands over a form called An Important Message from Medicare About Your Rights. Staff call it the IM. Your parent signs it somewhere in the blur of intake, between the armband and the allergy questions, and it goes into a folder nobody opens again.
That form is the whole appeal. It explains the right to stay while a decision is reviewed, and it carries the phone number to call. Medicare also requires the hospital to put it in front of you a second time before discharge. If the first copy was handed over more than two days before the discharge day, the hospital must give back a copy of the signed original or produce a fresh one to sign.
If you have never seen it, ask. Medicare's own guidance is blunt about this: if you do not get the notice, request it. A case manager who cannot produce it is a case manager who has skipped a required step, and saying so out loud tends to change the temperature of the conversation.
One threshold matters before any of this applies. The IM and the appeal below are for inpatients. If your parent is in a bed but classified as an outpatient receiving observation services, this is a different fight with a different notice, and we walked through it in the observation status guide. Confirm the classification in writing before you do anything else.
What a fast appeal actually buys you
The mechanism is called a fast appeal, and it is reviewed by an independent contractor Medicare calls a Beneficiary and Family Centered Care Quality Improvement Organization, or BFCC-QIO. It costs nothing. You do not need a lawyer, a doctor's signature, or the hospital's permission.
The deadline is the part people miss. You must make the request no later than the day your parent is scheduled to be discharged, while still in the hospital. Not the day after. Not on the drive home while you rethink it.
If you make that deadline, two things happen immediately. Your parent does not have to leave the building, and you are not responsible for the cost of those extra days beyond the usual coinsurance and deductible while the review runs. The QIO then notifies the hospital, and by noon the following day the hospital must hand you a Detailed Notice of Discharge setting out exactly why it believes covered care should end, which Medicare rule it is relying on, and how that rule applies to your parent specifically.
The QIO issues its decision within one day of receiving the information it asked for. So realistically an appeal buys you a day or two of calendar time. That is not nothing when you are trying to get a bed confirmed. But the more valuable output is often the Detailed Notice itself: it forces a reasoning that has until then only existed as a hallway sentence into a written document you can hand to the next provider, or to a lawyer, or to your siblings.
In Texas, you call Acentra Health
There are two BFCC-QIO contractors covering the country, and the one you need depends on where the care happened, not where you live. Texas sits in Region 6, along with Arkansas, Louisiana, New Mexico and Oklahoma. Region 6 is Acentra Health. The beneficiary helpline is 1-888-315-0636, TTY 711.
The other contractor is Commence Health, which handles Regions 2, 3, 5, 7 and 9. It has nothing to do with a discharge from an Austin hospital. This trips families up more than it should, partly because Commence Health was called Livanta until it was renamed in August 2025, and a great deal of printed material and cached web content still uses the old name and the old regional maps.
The safest move is to use the number printed on the Important Message from Medicare itself, because that copy is specific to the hospital and the patient. If you cannot lay hands on the form, call the Texas helpline above and they will route you.
Acentra also runs something newer called Immediate Advocacy Discharge Assistance, for people with Original Medicare who are in an acute care hospital and have been told a discharge is planned. It is a lighter-touch service: staff will explain the discharge plan in plain language and help you get your questions in front of the case manager. Be clear about its limits, because they matter. It does not review medical records, it cannot decide whether care is medically necessary, it cannot move the discharge date, and critically it does not pause or extend the appeal deadline. If you want the appeal, file the appeal.
What happens if the appeal goes against you
Most people hesitate here, so it is worth being specific about the downside. If you met the deadline and the QIO agrees with the hospital, you are still not responsible for the hospital charges through noon of the day after the QIO delivers its decision. Care your parent receives after that point may be on you.
In other words, filing on time and losing leaves you roughly where you started, plus a written explanation you did not have before. The financial exposure people fear mostly does not exist inside the deadline.
Outside the deadline is a different story. If the discharge day passes and you then ask for a review, the QIO will still look at it, but different rules and timeframes apply and you can be responsible for the cost of the stay past the original discharge date. This is the single reason to make the call the same day rather than sleeping on it.
None of this obligates you to appeal. Sometimes the discharge is right and the fight is with the plan for what comes next rather than with the hospital. But the decision should be yours, made knowingly, rather than defaulted into because nobody mentioned the option.
The choice you are not told you have
Separate from any appeal, federal law gives you more control over where your parent goes than most discharge conversations suggest. The rule is 42 CFR 482.43, a Medicare condition of participation every hospital must meet to keep billing Medicare.
When the discharge evaluation indicates skilled nursing, inpatient rehab, a long-term care hospital or home health, the hospital must include in the discharge plan a list of Medicare-participating providers of that type serving the geographic area you ask about, and must document in the chart that the list was presented. Not the short list of places that answered the fax first. The list.
The hospital must also inform you of your freedom to choose among participating providers, and the regulation states plainly that the hospital must not specify or otherwise limit the qualified providers available to you. On top of that, it must identify any home health agency or skilled nursing facility on that referral in which the hospital has a disclosable financial interest, and since the 2019 revision it must actively help you choose by sharing quality and resource-use data relevant to your parent's goals of care.
Two questions put all of that to work, and a case manager is required to answer both. May I see the full list of Medicare-participating facilities serving this area? And: Does this hospital have a financial interest in any of the providers on it?
One honest limit. This rule reaches Medicare post-acute providers. Assisted living and memory care are not Medicare benefits, so no hospital is obligated to hand you a list of them, and the referral sheet you get is usually a relationship list rather than a market survey. That search stays yours. Start with the Austin-area directory and check the license and inspection history yourself before you agree to anything.
The second discharge is the one that surprises people
Families brace for the hospital discharge and get blindsided three weeks later, when the rehab facility decides Medicare-covered therapy is finished. The same appeal right exists there, with a different form and a stricter clock.
In a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility or hospice, you should receive a Notice of Medicare Non-Coverage at least two days before covered services end. If it does not arrive, ask for it, exactly as with the IM.
The deadline here is the trap: you must request the fast appeal by noon on the day before the termination date printed on the notice. That is earlier than the hospital rule, and a notice that lands on a Friday afternoon can quietly consume your entire window over a weekend.
The review runs the same way. The provider must give you a Detailed Explanation of Non-Coverage, and the QIO decides by close of business the day after it receives what it needs. If you miss the window, coverage of anything past the end date on the notice is at risk.
Practically, the day a therapist first uses the word plateaued is the day to start watching for that envelope. Medicare coverage does not require continued improvement, and a plateau alone is not a lawful reason to end skilled care. Our page on what Medicare does and does not pay for lays out where the boundaries actually sit.
Same federal rules at every Austin hospital
These are conditions of participation, so they apply identically across the metro. At Dell Seton Medical Center at The University of Texas, the region's Level I trauma center and Dell Medical School teaching hospital at 1500 Red River St. At Ascension Seton Medical Center Austin on West 38th. At St. David's Medical Center on East 32nd, and at the South Austin and North Austin campuses. At Baylor Scott and White Medical Center Austin out on the US 290 service road, and at the Round Rock, Georgetown and Pflugerville campuses across the northern suburbs.
What differs between them is not the rulebook but the staffing: how many case managers are working a floor, whether anyone returns calls on a Sunday, how long a bed offer stays open. We are not going to publish campus-by-campus discharge timelines, because no Austin hospital publishes them and inventing them would be worse than saying nothing.
One newer requirement is worth knowing about. Since July 1, 2025, hospitals must maintain written policies and procedures for transferring patients to the appropriate level of care and must train relevant staff on them annually. If a transfer is being proposed and the reasoning is thin, asking to see the written transfer policy is a fair and specific request.
The five questions to ask a case manager, and how the notice window usually plays out in practice, are set out in more depth on our Austin hospital discharge planning page and in the situation walkthrough for a discharge inside 72 hours.
What to do in the next hour
Find the Important Message from Medicare, or ask the nurse or case manager for a copy. Read the phone number off it.
Get the inpatient-versus-observation classification confirmed in writing. Everything above depends on it.
If you believe the discharge is unsafe, call Acentra Health at 1-888-315-0636 before the end of the scheduled discharge day. Do it from the room. Do not wait until you have talked to your brother.
Ask for the full list of Medicare-participating post-acute providers serving the area you want, and ask directly about the hospital's financial interests in any of them. Write down who you asked and when.
After your parent lands somewhere, the hospital appeal machinery no longer applies, and a different set of numbers takes over. Complaints about a licensed Texas facility go to HHSC Complaint and Incident Intake at 1-800-458-9858. Concerns about care, rights or an improper transfer inside a facility go to the Austin-area long-term care ombudsman, Capital Area Area Agency on Aging, at 512-916-6054. That office is free, confidential, and independent of the facility; more on how to use it is on our ombudsman page.
