October 17, 2024
Policy Update: Final Rule on Medicare Beneficiaries’ Appeal Rights for Certain Changes in Patient Status
In response to a court order, the Centers for Medicare & Medicaid Services (CMS) has finalized appeals processes for certain Medicare beneficiaries who are initially admitted as hospital inpatients but are subsequently reclassified as outpatients receiving observation services during their hospital stay, along with other eligibility criteria.
This final rule establishes processes for
- Standardized appeals,
- Expedited appeals,
- and retrospective appeals for beneficiaries.
It also extends the timeframe for providers to submit a claim following a favorable decision and to submit records as requested by a contractor.
While CMS estimates a relatively low number of appeals that meet these criteria, they acknowledge that there will be administrative costs for hospitals to accommodate the new appeals process.
This final rule is effective October 11, 2024.
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