Thursday, January 09, 2014

Medicare trips up inpatients with "under observation" classification, forcing copays, denying rehab

Medicare patients admitted to hospitals need to make sure that Medicare classifies them as truly “inpatient” (Part A) and not “under observation”, the two hidden dirty words.  If patients are classified at admission as “observation”, they could be billed for charges (at least for the copays under Part B, for outpatient), sometimes even years later, and might not qualify for skilled nursing care (SNF).
My own mother had two periods of SNF care at facilities in Arlington, VA, once in 1999 after coronary bypass surgery, and in 2009 after a stroke.  Both were fully covered.  But based on this report, I wonder if I could hear about this again.  She passed away at the end of 2010 at age 97, and I am in charge of the estate.
Medicare Supplemental policies have help alleviate this risk.  It’s not clear how Medicare Advantage plans might respond.
The Wall Street Journal had reported on the problem Oct. 19 with an article by Anne Tergesen, here
NBC News reported on this problem tonight.

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