(b)Definitions. For the purposes of the appeals conducted under §§ 405.931 through 405.938, the following definitions apply: Eligible party means a beneficiary who, on or after January 1, 2009, meets the following criteria, and is, thus, eligible to request an appeal under §§ 405.931 through 405.938:
(i) Was formally admitted as a hospital inpatient.(ii) While in the hospital was subsequently reclassified as an outpatient receiving observation services (as defined in § 405.931(h)).(iii) Has received an initial determination (as defined in § 405.920 ) or a Medicare Outpatient Observation Notice (MOON) (as described in § 489.20(y) ) indicating that the observation services are not covered under Medicare Part A.(iv)(A) Was not enrolled in the Supplementary Medical Insurance program (that is, Medicare Part B coverage) at the time of beneficiary's hospitalization; or(B) Stayed at the hospital for 3 or more consecutive days but was designated as an inpatient for fewer than 3 days, unless more than 30 calendar days has passed after the hospital stay without the beneficiary's having been admitted to a SNF.(v) Medicare beneficiaries who meet the requirements of the paragraph (iv)(A) or (B) of this definition but who pursued an administrative appeal and received a final decision of the Secretary before September 4, 2011, are excluded from the definition of an eligible party.Eligibility contractor means the contractor who meets all of the following:
(i) Is identified on the Medicare.gov website for accepting appeal requests.(ii) Receives appeal requests and makes determinations regarding eligibility for the appeal under §§ 405.931 through 405.938.(iii) Issues notices of eligibility.(iv) Refers valid appeal requests to the processing contractor for a decision on the merits of the appeal.Processing contractor means the contractor responsible for conducting the first-level appeal and issuing a decision on the merits of the appeal. Appeals under § 405.932 are conducted by the MAC who, at the time of the referral of the request for appeal under § 405.932(d)(2), has jurisdiction over claims submitted by the hospital where the eligible party received the services at issue.