(Washington, D.C.) – Provider magazine is reporting this week about U.S. Senate hearings focusing on Medicare requirements for hospital stays. Senators have learned the use of the observation status for Medicare recipients has created a confusing situation that costs seniors emotionally and financially.
Prevent paying privately by asking about your hospital status
If you’re a senior and have to go to a hospital, it’s important to ask hospital staff if you have been “admitted” as an inpatient or if you are in “observational status.” This simple question can make the difference between Medicare Part A paying for rehabilitation and skilled care after a hospitalization, or you paying privately for that care.
In order to have rehab and skilled care paid by Medicare, a senior must first be admitted to a hospital for at least three consecutive days. Hospitals are not required to tell patients they are in observation status.
What should you do?
If the hospital says you or your family member is in observational status, demand an immediate review by the hospital in hopes of being admitted as an inpatient. The hospital decision can be appealed to Centers for Medicare and Medicaid Services (CMS).
What’s an example of this?
Your mother falls at home and dislocates her hip. She stays in the hospital for five days, all under observation. Her doctor recommends rehab at a local skilled nursing center. But because your mother was never admitted as an inpatient, you are now forced to pay for her rehab privately.
What happens to private payers?
Some seniors simply go home because they cannot pay for the rehab. But if they’re not properly healed, they may have to return to the hospital and pay additional expenses.
What should change?
Congress is working on a bi-partisan bill that would count any time spent in observation status as part of the three-day hospital stay requirement. This would allow Medicare to pay for rehab and skilled care after leaving the hospital. The bill is called the Improving Access to Medicare Coverage Act of 2013. The Good Samaritan Society is encouraging passage of this bill.