If your hospital stay was reclassified from inpatient to observation status, leading to denial of Part A coverage for post-hospitalization skilled care, you can now file a retroactive appeal. Post-hospitalization denials dating as far back as 2009 may be appealed.
The classification of your hospital stay is critically important because Medicare covers up to 20 days of post-hospitalization skilled nursing, and an additional 80 days with a deductible, only if you have been hospitalized for three or more days as an inpatient. As a result, many beneficiaries who did not realize their hospital stay was classified as observation status, or whose entire stay or a portion of it was reclassified from inpatient to observation status, have been shocked to learn that they are on the hook for post-acute care expenses.
If this is a situation you have found yourself in and you want to file a retroactive appeal, certain conditions must be met. The full list is too long to list in this post, so here are the basics:
- Hospitalization must have occurred after January 1, 2009.
- You were enrolled in original/traditional Medicare, Part A.
- You were admitted to the hospital as an inpatient, but then had your status changed to observation status, reducing your inpatient stay to less than 3 days.
- You were admitted to skilled nursing care within 30 days following hospital discharge.
Your appeal must be filed by January 2, 2026.
There are many more specific requirements needed to appeal. You can find details on the website of the Centers for Medicare and Medicaid Services. View them by clicking here. The form that you must submit to appeal, “Request for Retrospective Appeal Medicare Part A Form CMS-10885” is available on that page; scroll down to the bottom of the page to download it.
The Center for Medicaid Advocacy also has a page on their website that explains the appeals process, including answers to frequently asked questions. Click here.
