Did you know that when you or your loved one goes into a Medicare-participating hospital that you may not necessarily be considered an inpatient even though you are in a hospital bed for multiple days, or even weeks, receiving physician and nursing services, tests, medications, food and supplies? Instead you could be considered an outpatient under Observation Services.
Why should you be concerned? The financial implications are a major consequence for Medicare beneficiaries. Observation Services according to the Center for Medicare Advocacy, Inc., impact Medicare beneficiaries because the beneficiary could be denied coverage for a subsequent stay in a skilled nursing facility (nursing home stay for rehabilitation) on the grounds that they have not been an inpatient in the hospital for three or more consecutive days. A three day “inpatient” hospital stay is required before Medicare will pay for care and rehabilitation in a skilled nursing facility (SNF). Additionally, those under observation services may be liable for all hospital services and treatments including medications that are not covered under Medicare Part B.
The use of Observation Services is becoming more extensive by hospitals throughout the country. There is confusion among physicians as to what and how to write clear orders regarding Observation Services. Physicians may be advised to change a patients’ status from inpatient to outpatient under certain conditions. Therefore, patients who are in the hospital for more than a few hours should ask their doctor or hospital if they are an inpatient or an outpatient. There have been reports of beneficiaries staying in the hospital for more than 7-14 days and finding out they have been under Observation Services as an outpatient.
Why should you be concerned? The financial implications are a major consequence for Medicare beneficiaries. Observation Services according to the Center for Medicare Advocacy, Inc., impact Medicare beneficiaries because the beneficiary could be denied coverage for a subsequent stay in a skilled nursing facility (nursing home stay for rehabilitation) on the grounds that they have not been an inpatient in the hospital for three or more consecutive days. A three day “inpatient” hospital stay is required before Medicare will pay for care and rehabilitation in a skilled nursing facility (SNF). Additionally, those under observation services may be liable for all hospital services and treatments including medications that are not covered under Medicare Part B.
The use of Observation Services is becoming more extensive by hospitals throughout the country. There is confusion among physicians as to what and how to write clear orders regarding Observation Services. Physicians may be advised to change a patients’ status from inpatient to outpatient under certain conditions. Therefore, patients who are in the hospital for more than a few hours should ask their doctor or hospital if they are an inpatient or an outpatient. There have been reports of beneficiaries staying in the hospital for more than 7-14 days and finding out they have been under Observation Services as an outpatient.
Medicare's manuals define Observation Services as "a well defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment, that are furnished while a decision is being made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital" and further state that a patient should not remain in observation status for more than 24 or 48 hours.
If you discover that your hospital stay was considered Observation Services rather than inpatient and you believe this is incorrect, you can and should appeal the decision. Read more online at www.medicare.gov or to view the booklet “Your Medicare Rights and Protections” at http://www.medicare.gov/Publications/Pubs/pdf/11534.pdf.
If you discover that your hospital stay was considered Observation Services rather than inpatient and you believe this is incorrect, you can and should appeal the decision. Read more online at www.medicare.gov or to view the booklet “Your Medicare Rights and Protections” at http://www.medicare.gov/Publications/Pubs/pdf/11534.pdf.
Fiscal and physical prevention make sense, so be a savvy consumer by confirming your hospital status early on!
Cindy Hartman, RN, BSN
C&S Care Management, Inc.
Office: 281-550-8444
15430 Ridge Park Drive
Houston, Texas 77095
