Appeal when a hospital changes your status from "inpatient" to "outpatient getting observation services"

Starting on February 14, 2025, you’ll have the right to ask for a fast appeal if you were admitted as a hospital inpatient and your status was changed to “outpatient getting observation services” during your hospital visit. Your hospital status affects your bill and coverage if you need skilled nursing care after you leave the hospital.

If your status is changed from “inpatient” to “outpatient getting observation services” during your hospital stay, you should get a "Medicare Change of Status Notice (CMS-10868)" before you leave the hospital. If you don't get this notice, ask for it. This notice explains:

  • Your hospital stay will be billed to Medicare Part B instead of Part A. Depending on the Part B coinsurance you owe as an outpatient, your hospital bill may be lower or higher than the Part A inpatient deductible.
  • Your stay will be billed as an outpatient if you don’t have Medicare Part B. This means the hospital will charge you the full cost of your outpatient hospital stay.
  • Medicare won’t pay if you go to a skilled nursing facility after you leave the hospital.
  • Your right to a fast appeal and information on how to contact your state Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) to ask for a fast appeal.

If you have questions about billing, ask your hospital for more information.

If possible, it’s best to file an appeal while you’re still in the hospital. However, you still have appeal rights and can ask for an appeal after you leave the hospital. Follow the instructions on your "Medicare Change of Status Notice (CMS-10868)." If you can’t find the notice, you can get the phone number for your local BFCC-QIO and contact them to file an appeal.

What happens after I file an appeal?

When the BFCC-QIO gets your appeal, the BFCC-QIO will:

  • Let the hospital know that you filed an appeal.
  • Ask the hospital for your medical records and any relevant information.
  • Give the hospital a chance to explain why the change in status from an inpatient to an outpatient receiving observation services is appropriate.
  • Look at your medical records and the information provided by the hospital.
  • Make a decision and let you know what they decided about 2 days after you file your appeal.


You can ask for copies of any of the materials that were sent to the BFCC-QIO.

What happens when my appeal is decided?

The BFCC-QIO will notify you and the hospital once your appeal is decided.

  • If they decide that your status shouldn’t have changed: You’ll be responsible for paying the Medicare Part A inpatient hospital deductible. You may qualify for a Medicare-covered skilled nursing facility stay within 30 days of your discharge from this hospital stay (if other coverage requirements are also met).
  • If they decide that your status should have changed: You’ll be responsible for paying the Medicare Part B costs (if you have Medicare Part B). If you don’t have Medicare Part B, you may be responsible for the full cost of your outpatient hospital stay. You won’t qualify for a Medicare-covered skilled nursing facility stay after you leave the hospital.