News: CMS proposed rule offers Medicare patients the ability to appeal outpatient 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.

According to the American Hospital Association (AHA), the proposed rule is “the result of a nationwide class action case filed in 2011,” which eventually resulted in the legal establishment of “additional appeals processes for Medicare beneficiaries who were admitted as an inpatient but whose status changed to outpatient during their hospital stay.”

The CMS proposed rule contains three types of appeals (all of the following apply to Part A Medicare patients):

• Expedited appeals: According to the proposed rule, under this type of appeal “[e]ligible beneficiaries would be entitled to request an expedited appeal” before being discharged from the hospital.
• Standard appeals: The proposed rule noted that this type of appeal is for beneficiaries who are similarly eligible for an expedited appeal but “filed outside of the expedited timeframes.”
• Retrospective appeals: This type of appeal process pertains to Part A Medicare patients (and recipients of “certain SNF [skilled nursing facility] services, as applicable”) who experienced “status changes that occurred prior to the implementation of the prospective appeals process, dating back to January 1, 2009.”

The comment period for the proposed rule is set to expire 60 days after its release in the Federal Register.

Editor’s note: To read the AHA press coverage, click here. To read the CMS proposed rule, click here.