Can You Appeal When a Hospital Considers You an Outpatient?
Entrusted Legacy Law
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Jan 12, 2023
Pennsylvania - Greater Pittsburgh Area
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A hospital’s classification of you as inpatient or
outpatient can significantly affect Medicare’s coverage, shaping how much you
pay for services and whether your coverage includes care in a skilled
nursing facility.
Medicare Part A pays for inpatient hospital and
post-hospital extended care, including care in a skilled nursing facility
following admission to a hospital. However, it doesn’t cover outpatient care,
which typically falls under Medicare Part B.
To receive coverage for post-hospital nursing home care
under Part A, you must have been an inpatient in a hospital for at least three
days.
As Medicare.gov explains, individuals become
inpatients after the hospital formally admits them per a doctor’s order. The
day the hospital discharges them constitutes the last inpatient day.
Who Is Considered an Outpatient?
Individuals who receive care in hospitals that don’t
formally admit them are regarded as outpatients. People receiving emergency
department services, observation services, outpatient surgeries, lab tests, or
X-rays are outpatients. Even when these individuals spend the night in the
hospital, Medicare still considers them outpatients.
When a hospital reclassifies you from an inpatient to an
outpatient receiving observation services, you could lose Part A coverage. This
is because Medicare Part A doesn’t cover post-hospital extended care for those
classified as outpatients.
If your hospital changed your status from inpatient to
outpatient, you have the right to challenge the status change. Upon
your appeal, Medicare must reconsider its decision and might change your status
back to inpatient, allowing Medicare Part A coverage to take effect.
Court Order
In the past, beneficiaries lacked the right to appeal status
changes from inpatient to outpatient. The Center for Medicare Advocacy secured
these appeal rights for Medicare beneficiaries in a 2020 class action lawsuit,
which the federal court affirmed in January 2022.
The court required Medicare to have appeal procedures in
place for hospitalized beneficiaries reclassified from inpatients to
outpatients getting observation services.
Appeals Process
Medicare.gov explains the process for appealing a
reclassification and who qualifies for an appeal.
You have the due process right to appeal if you meet the
following requirements:
- On or
after January 1, 2009, a hospital accepted you as an inpatient, then
designated you as an outpatient receiving observational service.
- A
Medicare Outpatient Observation Notice (MOON) or a Medicare Summary
Notice (MSN)notified you that Part A doesn’t cover your observation
services.
To appeal, you must also meet one of the following criteria:
- At the
time of your hospital stay, you weren’t enrolled in Medicare Part B.
- Alternatively,
you were enrolled in Part B, stayed at the hospital for three or more
concurrent days without being an inpatient for at least three days, and
entered a skilled nursing facility within 30 days after your hospital
stay.
You can also appeal if it’s been less than 30 days since your hospital stay.
When Can You Appeal?
According to Medicare.gov, the appeals process for
reclassifications has yet to be made available. Generally, Medicare has a five-step
appeals process.
If you win your appeal, Medicare must disregard your
reclassification as an outpatient. It also must consider you an inpatient to
determine Part A Benefits, including coverage for your stays in a hospital and
skilled nursing coverage facility.
Speak to us to learn more about challenging your status change.
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