Medicare beneficiary changes
If you are a Medicare beneficiary, make sure you are aware of the Medicare changes that occurred in over the past 7 years in regards to what your patient status is during your hospital stay. Not asking the right questions can cost you thousands of dollars out of your pocket.
Is your patient status “admitted inpatient”? Admitted inpatient has a diagnosis code for billing. Which means a doctor has made a diagnosis and it can be given a corresponding number by which the hospital bills the charges.
Or, is your patient status “observation care”. Medicare considers observation care an outpatient service – so that more test and lab work can be performed, the patient may spend one or more nights in the hospital. Most commonly the observation status occurs because the patient is not sick enough to require admission or there is not a specific diagnosis. Either your doctor or a hospital representative can tell you what your patient status is, but you need to ask specifically.
The challenge with this change to Medicare is that when seniors are not admitted into the hospital and remain in
observation care, they are held responsible for outpatient copayments and prescription drug costs. There is also no out-of-pocket cap on these costs. Furthermore, and perhaps more importantly, should you be discharged to skilled nursing or rehabilitation care when leaving a hospital observation stay, none of the subsequent skilled nursing or rehab care cost will be covered by Medicare. A stay in Skilled or Rehab can cost thousands of additional dollars out of your pocket.
It also is important to know that Medicare requires three consecutive midnights as an admitted inpatient before being discharged to skilled nursing or rehabilitation care.
Currently, only 2 states have legislation that requires doctors and hospital officials to notify the beneficiary of the observation status. At a recent hearing held by the Senate Special Committee on Aging, there was agreement that this Medicare requirement needs to change and have cosponsored legislation, the “Improving Access to Medicare Act” would deem time spent in hospital observation status as inpatient care for the purpose of the Medicare three –day prior hospital stay requirement.
According to the Medicare Payment Advisory Commission, since 2007 Medicare observation patients has shot up 88 percent and according to the Inspector General of the US Department of Health and Human Services, in 20112 Medicare beneficiaries had more than 600,000 observations stays that lasted three nights or more.
As a senior you have worked hard for retirement money. Don’t let the hospitals take it away because you didn’t know your rights.