Tuesday, August 9, 2022
Update on Medicare Observation Status-Appeals Process Announced
The Center for Medicare Advocacy announced in their newsletter a few weeks ago that Medicare has announced the development of an appeals process for certain patients on observation status.
As the result of a court case, the Medicare.gov website now alerts a nationwide class of Medicare beneficiaries that they “have appeal rights” when a hospital changes their status from inpatient to outpatient observation, and that the appeal process is currently under development. View the information here (click on “Appeals in Original Medicare” and scroll to “Coming Soon: Appeal when a hospital changes your status from an inpatient to an outpatient with observation services.”).
The “observation” designation can have severe ramifications for beneficiaries. Many will face no coverage for post-hospital nursing home care, which requires a prior “inpatient” hospitalization of at least three days. Time spent in observation status does not count towards the required inpatient stay, even though observation stays can last several days and the care can be indistinguishable from inpatient care.
The full article is available here. Information about observation status appeals can be found here (click on appeals in original Medicare).