Medicare Fee for Service Beneficiary Appeals

Skilled Nursing Facility, Home Health Agency, Outpatient RehabilitationFacilities, Hospice Agency

You have guaranteed rights and protections as a person with traditional, fee-for-service Medicare coverage. Please become familiar with the following facts.

If you are receiving care from a comprehensive outpatient rehabilitation facility, home health agency, hospice, or skilled nursing facility, and you are told care is no longer needed and will no longer be covered by Medicare, you will receive an advance notice called Notice of Medicare Provider Non-Coverage at least two days before the services being provided are to end.

If you don’t agree that Medicare should stop covering your care, the notice explains how you can request and appeal.

To request an appeal, call TMF at 1-800-725-8339. You may reach TMF seven days a week, including holidays. Calls received after business hours will be returned the next day.

When you ask for another opinion, your Medicare Quality Improvement Organization will review your case to determine if Medicare will continue to pay for your care.

Please be sure to share this information with your family.

For more information on Medicare, please call the Medicare Helpline at 1-800-MEDICARE (633-4227).