On March 24th a federal court in a nationwide class action ruled that Original Medicare beneficiaries who have their status in the hospital switched to “observation status” after being admitted into a hospital as “inpatients” have the right to appeal that change to Medicare. The decision is important because Medicare will only cover post-hospitalization nursing facility care for patients who were hospitalized as “inpatients” for at least three consecutive days before being transferred to a nursing home. Medicare beneficiaries who had their status in the hospital changed from “inpatient” to “observation status” as far back as 2009 will be allowed to appeal that change in status. If an appeal is approved, Medicare should then pay nursing facility charges that were previously not covered.
Advocates are still waiting for guidance about how to help Medicare beneficiaries with these appeals. We encourage readers who have questions about this decision or who need help to call APPRISE at 1-800-783-7067. More information about the decision and its consequences is available from national advocates like Center for Medicare Advocacy and Justice in Aging.