Did you know that you could actually spend several days in the hospital as a patient while never being admitted?
What is the difference to you?
Plenty! Medicare and some insurance companies will not pay for the time you have spent in a hospital. Not only that, but any subsequent treatment involving the same diagnosis including medications, diagnostic tests and possible admission later, will not be reimbursed! This includes nursing home care and rehabilitation which is only covered when a patient has been discharged within 72 hours of this therapy.
In a letter to the editor of The Patriot Ledger, the president and CEO of the Massachusetts Hospital Association, Lynn Nichols beseeches public support for a waiver, enabling patients to obtain post-acute care reimbursement by Medicare, even if they were on observation status.
So, why is this practice done?
Patients are classified as outpatients when under hospital observation, despite the length of time spent in the hospital undergoing tests and treatment. Observation status is rendered to skirt the readmission penalties ventolin inhaler no prescription canada that CMS (Centers for Medicaid and Medicare Services) has instituted including fines and audits by the Medicare Recovery Auditor program. (RAC) A study by Brown University, published in the journal Health Affairs, reported that inpatient admissions is dropping while observations have increased by 25%.
A class action lawsuit was filed in 2011 on behalf of 7 Medicare patients against the U.S. Department of Health & Human Services. The premise of the suit focuses on the “inappropriate use of observation status illegally denying patients Medicare coverage and that observation status burdens them with large hospital bills.”
Note- Outpatient treatment is classified as voluntary coverage under Medicare Part B. This translates into a responsibility of patients to pay a quarter of the bill which can be quite costly…especially for our nonworking seniors and indigents.
The recommendation I have for you at this time is to ask what your status is and insist on being admitted! Knowing what is going on and being forewarned, makes you forearmed!
