Update from the Center for Medicare Advocacy, Inc.

On August 2, 2013 the Centers for Medicare and Medicaid Services (CMS) made a decision on Observation Services.  The decision was not to make a decision related to Medicare beneficiaries!  After pages and pages of regulatory discussion and evaluation, it appears that CMS did not make a conclusive decision on whether the time spent in observation status will be counted toward the three day hospital stay to qualify for Skilled Nursing Facility (SNF) care.

Be an advocate for all Medicare beneficiaries by calling your local representatives and bringing the unfair practice of cost shifting through observation status to their attention!  Help end observation status now!  Go to www.medicareadvocacy.org  and read Observation Status: OIG Provides an Analysis and CMS Issues Final Regulations and Now is the Time to End "Observation Status."

Are You or Your Loved One Covered by Medicare?

Are you or your loved one covered by Medicare? Yes?  Then educating yourself about Observation Services/Observation Status may save you money.

When a patient is under observation status, Medicare only covers outpatient costs.  The beneficiary must pay a co-payment for all treatments, medications, testing and labs.  As you enter the ER, you are stopped to complete paperwork for your very ill loved one.  Do you read and understand every document?  Probably not.  You are concerned that they are receiving the best care and quickly!  What you may not know is that the hospital is asking you to sign a document that says the beneficiary may be under observation services/status (outpatient) and is responsible for co-payments.  This is cost shifting, shifting more of the cost of medical care to the beneficiary.

ASK if you are an inpatient or an outpatient.  It may seem that you are an inpatient because you are wearing a gown, in a bed and receiving x-rays, treatments, medications and even having blood drawn.  But...that doesn't mean you are ADMITTED to the hospital as an inpatient.  You may even go to a room and stay 3 or more days...and still not be an inpatient.

ASK your doctor, the case manager and the billing department if you are admitted as an inpatient or outpatient.  ASK the billing office to estimate your out of pocket costs as an outpatient.

ASK if you are an inpatient and qualify for rehabilitation under Medicare in a Skilled Nursing Facility.  Have the Skilled Nursing Facility verify you were admitted to the hospital as an inpatient for three consecutive 24 hour periods and are covered by Medicare for rehabilitation services.  Otherwise you may be responsible for a huge bill from the rehabilitation facility.

Ask those in the House of Representatives to support H.R. 1179: Improving Access to Medicare Coverage Act of 2013 and in the Senate to support S. 569: Improving Access to Medicare Coverage Act of 2013.

Start a conversation with your loved one about the care they want and need.  Discuss the options for care, how to stay out of the hospital and if they want heroic measures performed.

Stay tuned for the changes coming to Medicare!