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  • Washington Highlights

    CMS Proposes New Appeals Processes for Hospital Patients


    Gayle Lee, Director, Physician Payment & Quality
    For Media Inquiries

    On Dec. 21, 2023, the Centers for Medicare & Medicaid Services issued a proposed rule that provides an appeals process for Medicare beneficiaries who were admitted as hospital inpatients but are subsequently reclassified at outpatients receiving observation services. The rule was issued following a January 2022 U.S. Court of Appeals for the Second Circuit decision ordering the Health and Human Services secretary to establish an additional appeals process for these patients. The rule proposes an expedited appeal for beneficiaries who appeal their hospital status prior to discharge from the hospital, a standard appeal for those who appeal after hospital discharge, and a retrospective appeal for beneficiaries that were part of the class action suit.