CMS Pub. 100-04, ch. 30, § 450.2

The expedited determination process is available to beneficiaries in Original Medicare

who, after formally being admitted as an inpatient, have subsequently been reclassified

by the hospital as an outpatient receiving observation services. The reclassification must

have happened while the beneficiary was still in the hospital, and also met one of the

following criteria:

• For beneficiaries with Medicare Part B, their stay in the hospital must last at

least three days.

• For beneficiaries that do not have Medicare Part B, no three day stay is required

to qualify for this expedited appeals process.

NOTE: For purposes of these instructions, the term “beneficiary” means either

beneficiary or representative, when a representative is acting on a beneficiary’s behalf.

Hospitals Affected by these Instructions. These instructions apply to any facility

providing care at the inpatient hospital level, whether that care is short-term or long-term, acute or non-acute, paid through a prospective payment system or other

reimbursement basis, limited to specialty care or providing a broader spectrum of

services. This definition includes critical access hospitals (CAHs).