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General interest items edited by Janice Flahiff

[Repost] Feds Refuse To Shut Down Controversial ‘Two-Midnight’ Rule For Hospitals

English: Bryce Hospital, Admission Unit

English: Bryce Hospital, Admission Unit (Photo credit: Wikipedia)


From the 3 October 2013 article at Forbes with Evan Albright, Contributor


The federal agency in charge of Medicare announced that for the next three months it will relax enforcement of its controversial “two-midnight rule,” but will not eliminate it per the desires of healthcare providers and now members of Congress.

Earlier this year the Centers for Medicare and Medicaid Services (CMS) announced a new standard for determining whether a patient is admitted to a hospital or there for observation, the two-midnight rule. Medicare patients must spend at least two continuous midnights in a hospital to be classified as inpatient, a status which comes with the highest reimbursement rates. Patients who spend less than two midnights will be automatically considered outpatient or under observation status.

As with any rule there will be exceptions:…

For patients, the advice we offered a few weeks ago still stands: If you are admitted to a hospital, ask and ask often about your status. For more information about how to manage hospital visits, download this pamphlet from the United Hospital Fund, “Hospital Admission: How to Plan and What to Expect During the Stay.” The section pertaining to inpatient versus observation status begins on page 9.***




***From page 9 of Hospital Admission: How to Plan and What to Expect During the Stay


Hospital Admission or Observation Status?

Just because your family member is in a hospital bed, on a hospital unit, eating hospital food, and undergoing hospital tests does not automatically mean that he or she has been admitted to a hospital. Sometimes doctors want to watch a patient for a few hours or a day to see whether there is really a need to be admitted to the hospital. This is called “observation.” More patients are now in hospitals being observed rather than admitted. This is largely because of Medicare’s efforts to reduce expensive hospital admissions and possible readmissions.

Does it matter if your family member is admitted to the hospital or is just being observed? Yes, because Medicare pays for hospital admissions and observation differently. As a result, your family member’s part of the bill is likely to be higher if he or she is only being observed than if he or she were actually admitted.

Admission vs. Observation

Hospital admissions are covered under Medicare Part A. Under Medicare Part A, after a one-time deductible fee, all hospital costs are covered when a person is admitted as an inpatient.

page10image6320Observation status and emergency room care (without admission) are considered outpatient care, and are covered only by Medicare Part B. Medicare Part B treats each lab test, X-ray, and other service as individual items, each with a copay. Prescription drugs are not covered and may be a separate charge.

There’s more. To be eligible for Medicare-covered skilled nursing facility services, your family member must have been a hospital inpatient for at least three days. The observation days do not

The result? After 72 hours of observation, your family member will have a higher hospital bill and will not be eligible for Medicare- paid rehabilitation services in a skilled nursing facility. Note that these rules apply to regular (that is, fee-for-service) Medicare; if your family member belongs to a Medicare Advantage (HMO) plan, check with the plan for its requirements.

What can you do?

 In addition to all your other questions, ask repeatedly, “Has my family member been officially admitted to the hospital, or is he or she under observation status?” Your family member’s primary care doctor will probably not be involved in this decision.

 Make a note of each staff person’s response, including the name and date.

 The hospital can retroactively (after the fact) change the patient’s status from inpatient to outpatient. This change is supposed to be made while the patient is still in the hospital, with a written notification to the patient.

 If you do not receive this notification, or if you want to appeal the decision, you can contact your state Quality Improvement Office at name=QnetPublic%2FPage%2FQnetTier2&cid=11447678747 93








Read the entire article here



October 16, 2013 - Posted by | health care | , , , , ,

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