What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would establish an appeals process for Medicare beneficiaries who were admitted as an inpatient but whose status changed to outpatient during their hospital stay.
What else to know: Policies are being established in response to a court order following a class action case filed in 2011.
The CMS proposed rule would establish additional appeals processes for Medicare beneficiaries in certain circumstances. The proposed rule is the result of a nationwide class action case filed in 2011 and affirmed by the U.S. Court of Appeals for the Second Circuit in January 2022. It orders the Secretary of the Department of Health and Human Services to establish additional appeals processes for Medicare beneficiaries who were admitted as an inpatient but whose status changed to outpatient during their hospital stay.
The proposed processes include an expedited appeal for beneficiaries who appeal their hospital status during their stay, a standard appeal for beneficiaries who appeal after discharge from the hospital, and a retrospective appeal for beneficiaries involved in the class action suit. Under the proposed rule, providers cannot serve as a beneficiary’s representative. Notably, the proposed appeals processes would apply only to patients enrolled in traditional Medicare, not patients enrolled in Medicare Advantage.