CMS’ Proposed Rule Addresses Appeals Rights for Certain Changes in Patient Status

The proposed rule from the Centers for Medicare & Medicaid Services (CMS) is in response to a federal court ruling that affects Medicare beneficiaries who received “observation services” in a hospital as outpatients.  The case of Alexander v. Azar in the U.S. District Court of Connecticut was decided by a federal judge in March 2020 and requires that beneficiaries who are initially admitted as hospital inpatients, but are subsequently reclassified as outpatients (resulting in a denial of coverage for the hospital stay under Medicare Part A), are entitled to an appeals process if they meet other eligibility criteria. CMS is requesting comment from the public on this proposal to create a standardized notice advising beneficiaries of their rights to three types of appeal – expedited, standard, or retrospective – depending on the patient’s current status.

Comment by February 22

Read the full article here.

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