More than 1.3 million Medicare observation stay claims could be appealed if a class-action lawsuit against the government succeeds.
The lawsuit began Aug. 12 in federal court in Hartford, CT, and challenges a rule requiring three consecutive days as a hospital inpatient to receive Medicare skilled nursing coverage.
Observation care is an outpatient service and doesn’t qualify as a prerequisite for Medicare nursing home coverage, often leaving patients unexpected expenses.
The lawsuit is seeking to change the provision that Medicare disputes involving observation claims can’t be appealed.
If successful, people with Medicare who received observation care services for three days or more from January 2009 through 2017 would be able to file an appeal and seek reimbursement for bills the program should have paid.
From the September 2019 Issue of McKnight's Long-Term Care News
