CMS Proposes Rule To Establish Appeals Process For Medicare Patients Reclassified To Observation Status

CMS Proposes Rule To Establish Appeals Process For Medicare Patients Reclassified To Observation Status

McKnight’s Long-Term Care News (1/2, Henreckson) reports, “Medicare patients initially admitted to hospitals as inpatients but later reclassified as outpatients under observation would finally have a process to appeal those decisions, thanks to a long-awaited proposal from the Centers for Medicare & Medicaid Services.” Under the proposed CMS rule, “hospital and SNF patients who had their benefits denied after a change of classification would have multiple ways to appeal the change…including both a standard and an expedited process.” The “rule follows a class action legal battle – Alexander v. Azar – that has been ongoing since 2011. After Medicare patients won a victory in 2020, leading long-term care provider groups” including the American Health Care Association “were quick to provide their support for new Medicare appeals processes.”

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SNF QRP/QM Changes

The Centers for Medicare & Medicaid Services (CMS) is alerting Skilled Nursing Facility (SNF) providers of upcoming measure removals from the SNF Quality Reporting Program

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