If you are a Medicare beneficiary going to the hospital for anything other than an outpatient visit, be sure to find out if you are being admitted as an inpatient or under the designation “observation stay.”
If you require rehabilitation after your stay in the hospital, you will want to be admitted as an inpatient. If not, your stay might not count as a qualifying stay, according to Medicare regulations, and Medicare might not cover expenses for rehabilitation in a nursing home or home care after you leave the hospital.
Medicare will pay the cost of rehabilitation in a nursing home, for up to 100 consecutive days, only if the beneficiary stayed in a hospital as an inpatient for at least three consecutive days before being discharged.
Over the past several years, more and more hospitals are admitting Medicare beneficiaries as observation stays rather than inpatients in order to determine the cause for the hospital stay. This is because the federal government wants to reduce what they call “preventable or unplanned readmissions” to hospitals. Regulations to take effect next year will financially penalize hospitals for readmissions within 30 days of discharge, especially for patients admitted for heart attacks, heart failure and pneumonia.
The Centers for Medicare and Medicaid Services (CMS) encourages observation stays of less than 48 hours; however, they have not established a limit. Some hospitals allow observation stays as long as eight days. The most recent figures from CMS show observation stay hours in hospitals increased to 36 million hours in 2009, compared to 23 million in 2006.
The Good Samaritan Society strongly supports The Improving Access to Medicare Coverage Act of 2011, which was recently introduced in Congress (HR 1543 and companion bill S 818). It would change Medicare regulations so that observation days would count toward the three-day requirement.
Currently, if a Medicare beneficiary does not meet the three-day minimum inpatient requirement, he or she could spend out-of-pocket money for rehabilitation in a nursing home or home care. Supplemental insurance, long-term care insurance and prescription drug plans may help with some costs not covered by Medicare.
If you would like information on how to contact your elected officials to encourage them to support The Improving Access to Medicare Coverage Act of 2011, please contact me.
By Jeff Stingley
Director of Public Affairs