CMS has issued a final rule that establishes a patient status appeals processes for certain people in Traditional Medicare. Patients will be able to appeal if they are admitted to a hospital as an inpatient but subsequently reclassified by the hospital as an outpatient receiving observation services during their hospital stay, and who meet other eligibility criteria. The rule is the result of a judicial ruling determining that enrollees have the right to challenge such determinations and directed the government to establish a process for doing so. CMS made some changes from the proposed rule, including extending the timeframe for providers to submit records as requested by a contractor from 60 calendar days to 120 calendar days.

A CMS fact sheet on the final rule can be found here. CMS stated, “We are targeting January 1, 2025, for implementation of the retrospective appeals procedures. We are targeting February 14, 2025, for implementation of the prospective appeals procedures.” Further updates on the rule are expected to be posted here.