Medicare Appeals

The Colorado Foundation for Medical Care (CFMC) is the quality improvement organization (QIO) that is responsible for reviewing requests for expedited appeals in Colorado.

Beneficiaries have the right to an immediate, independent Medicare review (appeal) of a Medicare Advantage (MA) health plan's decision to end coverage of services. In addition to hospitals, these settings include comprehensive outpatient rehabilitation facilities (CORFs), home health agencies (HHAs), and skilled nursing facilities (SNFs).

Traditional Medicare fee-for service beneficiaries have expedited appeal rights. In addition to the hospital setting, beneficiaries in CORFs, HHAs, hospices, and SNFs also have rights to appeal the notice of non-coverage that a provider is required to issue prior to termination of services.

Since July 2, 2007, hospitals must deliver a revised version of the Important Message from Medicare to inform Medicare beneficiaries who are hospital inpatients about their hospital discharge appeal rights. Notice is required both for Original Medicare beneficiaries and for those enrolled in Medicare health plans.

CFMC Medicare Helpline

If you were issued a notice of Medicare non-coverage and you disagree that your services should end, please call the CFMC Medicare helpline at 303.695.3333 or
1.800.727.7086 to request an appeal.

CFMC performs expedited appeal reviews for CORFs, HHAs, hospice, and SNFs seven days a week, including holidays, 8 a.m. to 4:30 p.m. MST. Hospital reviews are performed seven days a week, including holidays, 8 a.m. to 4:30 p.m. MST.

A message can be left after normal business hours and a CFMC representative will call you back no later than the next business day.

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Contact Information

The Colorado Foundation for Medical Care (CFMC), the Medicare quality improvement organization for Colorado, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS Policy.