Medicare Patients Under “Observation Status” Win Right to Appeal

Print Friendly, PDF & Email

Courtesy of Justice in Aging

In a decision issued last week, a federal court judge in a nationwide class action ruled that Medicare beneficiaries who have been denied coverage for nursing facility services after transferring from hospitals because the hospital changed their status from “in patient” to “observation status” now have a right to appeal their classification, and potentially receive reimbursement from Medicare for the uncovered nursing facility charges.

The common hospital practice of admitting patients under observation status has led to denials of coverage for subsequent nursing facility stays because Medicare only covers subsequent care in a skilled nursing facility for patients who were hospitalized as inpatients for three or more consecutive days. This important decision will allow thousands of Medicare beneficiaries who were denied coverage for nursing home stays to appeal changes in status to “observation” going back to 2009.

Justice in Aging, Center for Medicare Advocacy and the law firm Wilson, Sonsini, Goodrich & Rosati represented the plaintiff class.

Read more about this win