One problem with Medicare has resulted in surprise costly billings to seniors. The root of the problem is billing codes. It is impossible to admit a senior to a hospital unless a valid Medicare billing code is assigned to the illness, and the patient's admission.
But what happens when a senior visits a hospital emergency room and they cannot immediately diagnose the illness? The hospital has two options: #1, they may send the patient home and risk a lawsuit for failing to correctly diagnose an illness; #2, they hold the senior for “observation” rather than admit them, knowing Medicare part A will not pay for care rendered while held on observation. During the period of "observation" the senior receives a hospital bed, nursing and medical care, diagnostic tests, treatments, therapy, prescription and over-the-counter medications, and food. Medicare B may pay for the stay, but there will be co-pays. The amount depends on the supplemental insurance the senior has purchased.
Much worse, if the hospital sends the patient to a nursing home for rehabilitative services, they may not be covered. A patient must be hospitalized for three days before Medicare covers nursing home care, and time spent on observation status does not count toward those three days. Since nursing home care averages over $200. per day, a short stay can deplete the savings of a senior.
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There are some who feel this is not enough. So, bipartisan legislation pending in Congress – H.R. 1179 and S.569 – the "Improving Access to Medicare Coverage Act of 2013" – would count the time in Observation Status towards meeting the requirement for a three-day qualifying inpatient hospital stay. As of August 1, 2013, H.R.1179, has 91 House co-sponsors including our Representative Allyson Schwartz. S.569, has 16 Senate co-sponsors, including our Senator Casey. In addition, many organizations have come forward in support of the legislation, including the National Academy of Elder Law Attorneys of which I am a member.
If you would like to contact your elected representative about this proposed legislation, the Center for Medicare Advocacy providesthis link to make it easier for you to do so.
In the meantime, if you are a senior and you are in the hospital, ask the hospital about your status. If they tell you that you are in observation status, appeal it immediately, if you can. If you are not able to do this yourself, obtain the help of a patient advocate or an Elder Law attorney.
Stay well until the next post.
Bob Gasparro
