CMS finalizes Medicare outpatient appeals process

The Centers for Medicare & Medicaid Services Oct. 11 issued a final rule establishing appeals processes for certain Medicare beneficiaries who are initially admitted as hospital inpatients but subsequently reclassified as outpatients receiving observation services. The rule establishes both retrospective and prospective appeal rights for beneficiaries and is a result of a court decision in the case of Alexander v. Azar. The AHA in February expressed support of CMS' general approach and offered recommendations to ensure beneficiaries better understand CMS policies and to help clarify and reduce the burden of these appeals on all parties involved. AHA members will receive an advisory with more information on the final rule.