Blog 
Click here to go back
Medicare Program: Appeal Rights for Certain Changes in Patient Status
Medicare Program: Appeal Rights for Certain Changes in Patient Status
CMS has issued a new proposed rule, which would mandate that patients be afforded the ability to appeal hospital reclassifications from inpatient to outpatient status.
The proposed processes would consist of the following:
• Expedited appeals: Proposes appeals for certain beneficiaries who disagree with the hospital's decision to reclassify their status from inpatient to outpatient receiving observation services (resulting in a denial of coverage for the hospital stay under Part A
• Standard appeals: Proposes that beneficiaries who do not file an expedited appeal would have the opportunity to file a standard appeal (that is, an appeal requested by a beneficiary eligible for an expedited appeal, but filed outside of the expedited timeframes) regarding the hospital's decision to reclassify their status from inpatient to outpatient receiving observation services (resulting in a denial of coverage for the hospital stay under Part A).
• Retrospective appeals: Proposes retrospective review process for certain beneficiaries to appeal denials of Part A coverage of hospital services (and certain SNF services, as applicable), for specified inpatient admissions involving status changes that occurred prior to the implementation of the prospective appeals process, dating back to January 1, 2009.
