Medicare Appeal Guide: Maximize Reimbursement and Patient Care
The Centers for Medicare & Medicaid Services (CMS) has implemented new rules to address a common issue faced by Medicare beneficiaries: incorrect classification of inpatient hospital stays as outpatient observation services. This reclassification can lead to significant financial burdens for patients, as it may result in denied coverage for hospital and skilled nursing facility (SNF) care. Who is Eligible for the Medicare Appeal Process? Medicare beneficiaries may be eligible to appeal if they: Were admitted to a hospital as an inpatient. Were subsequently reclassified as an outpatient receiving observation services. Received a Medicare Outpatient Observation Notice (MOON). Were not enrolled in Medicare Part B or stayed in the hospital for three or more days but were classified as inpatients for fewer than three days. New Appeal Options Medicare has introduced several new appeal options: Expedited Appeals: Beneficiaries can file an expedited appeal while still in the hospital to d
