If you—or your parents—have Medicare

[Spiky Bugger]

Try to not get screwed. But your hospital will be working against you. (Not technically NEWS, except to those who haven’t needed the info.)

Bottom Lines:
1–hospitals make more money if you are deemed by them to be on “observation status,“ as opposed to being “an admitted patient,” even if they perform a procedure and keep you for three days.
2–on Original Medicare, many charges are NOT covered if you are merely being “observed.”
3–and, if you—or your parents—need rehab time in a SNF after your hospital stay, Medicare will pay IF AND ONLY IF YOU WERE AN ADMITTED patient for “three midnights“ and discharge day does not count. They will pay NOTHING if you were deemed to be on observation status for any of that time.


Different states also have different laws.

This became a “family issue” yesterday when my sister said that the hospital is keeping her husband in a very nice room next to the ED so they can carefully observe him. She has a Medicare Advantage program (I think) and I cautioned her to call her insurance FIRST THING today to see what coverage they have.

The underlying problem here is, I think, that Medicare pays hospitals less if a patient is discharged and then is REadmitted within a short period. They solve that problem by not technically admitting some patients.

google: medicare hospital admit observation

and maybe add your state’s name

 

[Susan in Tennessee]

I know it’s that way in Missouri and here in Tennessee. Observation is a dirty word!

 

[k9ophile]

Since retiring, my memory on such things has become fuzzy but a quick search and a site called yourgpsdoc.com helped refresh it.
Observation status was originally created by the Center for Medicare and Medicaid Services (CMS) for Medicare patients treated in the Emergency Room who were too sick to be discharged, but who were felt to need a few additional (up to 24) hours of monitoring or care.

Now as you can imagine, under DRG reimbursement, things got crazy and GREED came into play big time. So of course some ass-hat(s) got the rules changed. A hospital is under no obligation to tell you that you're being admitted to OBS instead of a full admission. One only finds out when the outrageous bill is received. Because OBS status is actually considered to be "out patient" and NOT covered by the DRG system which is a set payment no matter how many days one is in the hospital. Believe it or not, many conditions can be managed in three days. Hence, changing OBS to 72 hours instead of 24 lets the hospital bill more and as Spiky so aptly pointed out, the patient gets stuck for a higher bill.

Again, I'm not up on the current rules, but when I was working, there was the Three Day Rule stating that a patient could not be admitted directly to a SNF. And Spiky is right, hospitals get dinged for re-admissions within a short period, usually 30 day. Because, you know, they were supposed to cure the patient the first time. And since the patient was obviously not cured and had to be re-admitted...

Again, don't take my word for any of this. The rules change faster the status of any Kardashian. Be like Spiky advocates and do some research on your state.