A major advocate for Medicare beneficiaries and about 40 cosigners are embracing a proposed process for observation stay appeals, calling it 15 years overdue in a formal comment letter set to be sent to federal regulators today.
Drafted by the Center for Medicare Advocacy and Justice in Aging, the letter urges the Centers for Medicare & Medicaid Services to move quickly to finalize the appeals rule proposed in December.
“Some members of the class and their families who have suffered significant financial and health costs have waited 15 years for a remedy,” the letter reads. “CMS must not make them wait any longer and must make this rule a top priority.”
The signatories notably ranged from consumer advocates like the National Consumer Voice for Quality Long-Term Care and the AARP, to leading care provider groups like AMDA The Society for Post-Acute and Long-Term Care Medicine to watchdogs like the National Association of State Long Term Care Ombudsman Programs.
Currently, Medicare patients who are initially classified as inpatients and later reclassified to outpatients under observation have no way to appeal the change in status. Such patients can be left with a large increase in medical bills and no recourse — leading to significantly higher care costs at hospitals and skilled nursing facilities. Some avoid a SNF stay all together to avoid the daily expense,
While generally supporting the proposed rule, the Center for Medicare Advocacy asked CMS to go even farther in some of its provisions — especially to increase awareness of new processes and give patients more time to take advantage of them.
For example, the letter calls for doubling the time limit for retroactive appeals to two years, publishing information about the new appeals process in more places where patients are likely to look, and providing additional guidance and clarity on how and what to properly submit in an appeal.
“People with Medicare who are switched from inpatient to outpatient receiving observation services while hospitalized have been without recourse for too long,” the groups concluded. “They deserve their appeal rights, and in many cases reimbursement for out-of-pocket costs that Medicare should have covered, right away.”
Two dozen public comments had been posted in response to the proposed rule Friday afternoon, ahead of the Monday deadline.
