Are You Being “Observed”?

Every year, thousands of Medicare patients spend time in the hospital for “observation,” but are not officially admitted. Many Medicare recipients don’t realize that the time they spend in the hospital under “observation” status cannot be counted towards the 3-day inpatient hospital stay required for Medicare coverage.  In these cases, Medicare will not cover any medications the hospital provides for pre-existing health problems. In addition, the biggest problem is often that any subsequent short-term rehabilitation services in a skilled-care facility are not covered if the patient was not formally admitted for at least 3 days.

Starting April 1, 2014, Medicare officials will start to enforce a new rule that will require doctors to admit patients they anticipate will stay longer than two nights. Those patients expected to stay for a shorter period of time will still be classified as “observation” patients.

The chance of being admitted varies depending on the hospital, the inspector general of the Department of Health and Human Services has found. Medicare doesn’t require hospitals to tell patients if they are merely being observed, which is supposed to last no more than 48 hours to help the doctor decide if someone is sick enough to be admitted.

Medicare officials have urged hospital patients to find out if they’ve been officially admitted. Below are some suggestions regarding this matter:

  • To increase the likelihood of being formally admitted, “get yourself in the door before midnight,” advised Dr. Ann Sheehy, division head of hospital medicine at the University of Wisconsin Hospital in Madison, Wisconsin.
  • “I would talk to anyone who would listen to me,” said Terry Berthelot, a senior attorney at the Center for Medicare Advocacy, which offers a free self-help packet for observation patients. “Make as much noise as you can, because it’s much easier to change your status while you’re still in the hospital than to go through Medicare’s appeals process later.”
  • Ask your regular physician to speak with the doctor treating you in the hospital about why you need to be admitted, based on your medical condition and risk factors.

If the situation isn’t resolved while you’re in the hospital and you require follow-up care at a skilled-care facility, you’ll have to pay the bill of often thousands of dollars, unless you file a successful appeal. The appeal process is long and arduous, and it requires beneficiaries to first receive and pay for the care — often an expensive proposition — before seeking reimbursement.

If you or a loved one is nearing the need for long-term care, in order to protect your family’s hard earned money and assets from these catastrophic costs, the best time to create your long-term care strategy is NOW.  Generally, the earlier someone plans for long-term care needs, the better.  But it is never too late to begin preparing.  Even if you are already in a nursing home receiving long-term care, it is nottoo late to do Long-term Care Planning, also called Lifecare Planning and Medicaid Asset Protection Planning. To make an appointment for a no-cost consultation, please call the Fairfax and Frederickburg Medicaid Asset Protection Law Firm of Evan H. Farr, P.C. at 703-691-1888 in Fairfax or 540-479-1435 in Fredericksburg.

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