After 11 years of legal battles, certain Medicare beneficiaries who have been under “observation status” while in the hospital can now file an appeal for payment of their nursing home coverage. The recent January 25th ruling that came in response to a 2011 class-action lawsuit against the Department of Health and Human Services is a huge victory for beneficiaries and will help prevent unnecessary financial strain due to catastrophic medical bills.
Medicare requires three days of “inpatient” hospital care before covering nursing home care — which means patients in the hospital who were coded as in “observation status” instead of “inpatient” were not eligible for this coverage. This has left many Medicare beneficiaries with huge medical bills and no way to appeal for coverage.
Now, with the new ruling, patients have the right to appeal to Medicare for nursing home coverage if they were admitted to a hospital as an inpatient but were switched to observation care, an outpatient service.
- Kaiser Family Foundation: Medicare Patients Win the Right to Appeal Gap in Nursing Home Coverage
- Center for Medicare Advocacy: Court Upholds Right to Appeal for Certain Beneficiaries on “Observation Status”