The Crucial Difference Between Being Admitted as an “Inpatient” or Being Listed as “Under Observation”
A special Message for Medicare Beneficiaries: Over the past ten years, there has been over a 65% increase in hospital patients being listed as ‘under observation’ instead of as an inpatient. Why you ask?
Inpatients cost considerably more than observation status patients, which is why Medicare aggressively reviews patients’ classifications. Hospitals are obliged to follow Medicare guidelines when assigning appropriate levels of care. A patient must be in the hospital for at least 2 midnights/ 3 days to qualify for Medicare’s nursing facility benefit. The patient must be in need of care that is only available by staying in the hospital, and the doctor’s notes must reflect that specific need for care. If a doctor reports inappropriately, the hospital may not get paid and the doctor could be accused of Medicare fraud.
This rule was created in 1965 and has yet to be altered, despite the multitude of disputes.
This fine print patient status can be the difference in thousands of dollars for Medicare, the hospital, or the patient. Almost 2 million people every year are stuck in this ‘observation’ category, leaving them financially buried when seeking rehab services. In the last year, there has been over a half a million cases of 3-day ‘observation stays’, despite proper inpatient criteria, that are denied rehab coverage upon release.
Seems unfair doesn’t it? After paying years of Medicare premiums, it does not seem right to be deprived of your benefits.
Here’s what you should do: Next time you or your loved one ends up in the hospital, make sure you have been admitted as an inpatient instead of just under observation. You have a right to appeal or challenge the decision with Medicare if you feel it is unjust.
Have your doctor “think in ink”. Make sure he or she fully discloses the extent of your necessary care. They need to have substantial evidence to support your length of stay, which can make for a more solid argument for your appeal. Lastly, get in touch with your congressman. There are bills in place that could help eliminate the 3-day inpatient requirement.
Medicare brings an important service to our nations seniors. SFG wants you to know how the Medicare system works and for you to also know what benefits are you are eligible for. To talk to a Senior Benefits Specialist call SFG at 865-777-0153! Medicare is no longer black and white! We are here for you!