CMS issued a proposed rule Dec. 21 that outlines a process for Medicare beneficiaries to appeal their observational status during a hospital stay.
The rule stems from a class-action lawsuit filed in 2011 on behalf of Medicare fee-for-service patients who didn't receive Part A coverage because hospitals did not designate them as inpatients. A court ruling — affirmed by a federal appeals court in 2022 — ordered HHS to create additional appeals processes for beneficiaries admitted as inpatients but whose status changed to outpatient during the hospital stay, according to AHA News.
The proposed rule outlines standard, expedited and retrospective appeals processes for eligible Medicare patients. Patients can only appeal status changes dating back to Jan. 1, 2009.
CMS is accepting comments on the proposed rule through Feb. 25.
Read the full rule here.