{"id":711,"date":"2016-05-12T14:02:02","date_gmt":"2016-05-12T18:02:02","guid":{"rendered":"http:\/\/bradleygreene.com\/?p=711"},"modified":"2016-05-12T14:02:02","modified_gmt":"2016-05-12T18:02:02","slug":"medicare-changes-demystified-understanding-observation-status","status":"publish","type":"post","link":"https:\/\/bradleygreene.com\/medicare-changes-demystified-understanding-observation-status\/","title":{"rendered":"Medicare Demystified: Understanding Observation Status"},"content":{"rendered":"

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\nOver the last several years, many unsuspecting seniors and disabled persons have been opening the mail to receive large bills for health care procedures and medications they assumed were covered during a recent hospital stay. Even worse, some patients have transferred to rehab after a hospital stay only to find out their skilled nursing care wasn\u2019t going to be covered and they would be billed at a cost of over $400 per day for care they needed to recover from an illness or injury.
\nThese situations are both a result of a technical, financial loophole in Medicare billing called \u201cObservation Status\u201d \u2013 and thankfully, as of August 2016 hospitals will be required to notify patients in writing if their stay is not going to be covered, so there should be less surprises in the mailbox.
\nBut that doesn\u2019t make the billing issue any easier to understand, and it doesn\u2019t ensure that people who need hospital care will be able to afford it. Here are a few of the key points you need to know about Observation Billing, Medicare Part A\/B coverage and Skilled Nursing Rehabilitation.
\nOutpatient Services<\/strong> \u2013 Covered under Medicare Part B (Outpatient Insurance) includes medical services that are typically performed in the community such as doctor visits, lab work, x-rays and some home health care.
\nObservation Status<\/strong> \u2013 If the hospital determines that they are \u201cwatching you\u201d overnight or collecting information to determine an accurate care plan and diagnosis, then you are probably being admitted under \u201cObservation Status.\u201d This means that any medications and services provided for pre-existing conditions will likely be billed under Medicare Part B, probably at a much higher rate than anything you would pay if you were getting those same meds from a local pharmacy.
\nInpatient Hospital Services<\/strong> \u2013 Covered under Medicare Part A (Hospital Insurance) and includes all hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term acute care hospitals.
\nQualifying Stay<\/strong> \u2013 This is the Medicare requirement that says in order for someone to have Skilled Nursing Facility (SNF) rehabilitation covered under Medicare Part A, he\/she must be admitted to an INPATIENT hospital bed at midnight for three nights in a row. The tricky part is that if the hospital is billing your stay as OBSERVATION status, then you don\u2019t qualify for the SNF benefit coverage.
\nHow to reduce the costs of care:<\/strong><\/p>\n