Posted on 06/24/2015 8:14:41 AM PDT by mac_truck
Days spent in the hospital as an outpatient, rather than being officially admitted, can leave Medicare patients with bigger bills.
It's bad enough spending three or more days in a hospital -- undergoing a barrage of medical tests and procedures. Brace yourself for even more pain at discharge if the hospital tells you that you were actually never admitted but were on Medicare "observation status." That designation could cost you big time.
Hospitalized Medicare beneficiaries who are under observation are considered outpatients, even if they spend many days in the hospital. If you find yourself in this boat, there's a chance you'll pay more for services than if you had been formally admitted. Observation patients are also ineligible for certain extended-care benefits.
In 2012, the number of hospital patients under observation status rose to 1.8 million, up 88% from 2006, according to federal data. During the same period, hospital admissions dropped. Federal investigators have found, though, that observation patients show similar symptoms as those admitted to the hospital. "It just doesn't make sense," says Toby Edelman, senior policy attorney at the Center for Medicare Advocacy.
When it comes to how Medicare covers your hospital stay, your designation makes all the difference.
(Excerpt) Read more at kiplinger.com ...
Wrong again. Medicare policy is less than 48 hour stay is obs, but even longer stays can be observation if they dont meet medicare requirement for inpatient status. This applies to any medicare subsidized policy.
My Mom just had a procedure done a few months ago and she went a few hours over the 24 hour outpatient period and they admitted her. When the bill came we were concerned about the cost but it showed her as an admitted patient.
I should have put a ‘/sarc’ tag for my post-—Michelle Obama didn't prioritize the patient when she would try to steer “non payers” to other hospitals. It's all about the Benjamins.
Certainly the blame is with Medicare but in reality, a doctor makes that decision and they are people, too. I suppose I could say it's “who you know”, the personal connection you have to your doctor. Plus, the doctor wants to be paid and he knows the hospital wants to be paid. What he puts on the chart decides where the medical bills go.
Our doctor, who had a personal relationship with my dying husband, kept him in the hospital rather than ship him to hospice where they would have let him die right then. When I asked him not to send him to hospice, he said, “I would never do that to him.” He wrote whatever he had to in order to keep him in that hospital and prolong his life.
I spend inordinate time during my day trying to justify inattentive status for patients and doing appeals with insurance companies it’s not the docs fault or our decision who is inattentive or outpatient the system is broken but only getting worse with obamacare
The doctor no longer makes the decision it is u to Medicare guidelines the hospitals hire utilization review people to be sure correct status is assigned I am a Hospitalist I know how this works I fight it every day.....
Then it was for a reason other than time medicares current inpatient criteria is 48 hours not 24 but you still need to meet inpatient criteria
It’s a nice sentiment and one can fudge for a day or two but all charts are reviewed by the insurance companies on an ongoing basis if I could just do what I wanted believe me I would make almost everyone inpatient the reality is that is not possible
bkmk
I’m on Medicare and this was the article that made me sit up and take notice.
Let me stat I am a physician. Medicare is the one who makes this decision. It is NOT the doctors decision. Every chart is reviewed by .gov bean counters. To LIE is fraud. If a physician gets caught padding the records for a “good “friend” that may very well be the end of their career and possible jail time.
If the dose of your med was less than the therapeutic dose for depression then you have good reason to fight the depression diagnosis.
The small pill is 50 mg. I was in private practice as a professional counselor when that med came on the market and was given for depression and I recall it was maybe 300 mg. for depression.
It was many years later when a neurologist prescribed that very small pill for overactive muscle movement.
The doc did change that reason for taking that pill. No way was I going to have “depression” on my medical record.
The doc did change that reason for taking that pill. No way was I going to have “depression” on my medical record.
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Good for you! :)
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