4 Replies Latest reply on Mar 31, 2012 2:23 PM by jkom51

    Medicare: Inpatient or Outpatient?

      It makes a difference:

      Hospital Observations Can Get Costly for Medicare Recipients

      Observation care is billed as outpatient care, leaving Medicare beneficiaries with higher out-of-pocket expenses.

      WSJournal FEBRUARY 5, 2012


      (Excerpt) Some Medicare beneficiaries who visit the hospital are getting surprised by big bills because their stays weren't considered inpatient services.


      The issue arises when a Medicare beneficiary who comes to a hospital is placed in a status called "observation care." This is supposed to mean that patient is being watched while doctors decide if she can be discharged, or if she is ill enough to be admitted as a true inpatient. Observation is typically supposed to last 48 hours or less.


      The number of observation hours grew to around 36 million in 2009, from 23 million in 2006, according to the Medicare Payment Advisory Commission. The commission also saw a growing number of stays lasting 48 hours or longer between 2006 and 2008.


      The problem for Medicare beneficiaries is that observation services can result in unexpected expenses. They are considered outpatient care—even if the patient is in the hospital for several days. That means the visit isn't included under Medicare Part A, which covers the total cost of hospital services after a deductible. Instead, the patient owes copayments for services under Medicare Part B, which covers outpatient care and doctors' work. (Beneficiaries who have Medicare Advantage coverage pay according to their particular plan's rules.)


      The biggest financial hit can actually come after the hospital stay ends. Medicare pays for nursing-home expenses only if the person was an admitted inpatient at a hospital for at least three days—not counting the discharge day. The nursing-home bill "means potentially thousands of dollars," says Frederic Riccardi of the Medicare Rights Center, based in New York.


      In a handout for beneficiaries, Medicare says patients should ask doctors whether they are considered inpatient or outpatient. One signal of inpatient status is being given a document titled "Important Message from Medicare," about inpatient rights. Still, sometimes a stay can be reviewed and switched from inpatient to outpatient while a person is still in the hospital.


        • Re: Medicare: Inpatient or Outpatient?
          Wow, jkom, interesting and scary! Just the fact that you can check on your status when you are first admitted to the hospital and then the hospital can change your status WITHOUT TELLING YOU and even change your status RETROACTIVELY after your discharge is incredible. 

          If you read the Comments at the end of the WSJ article, they explain why this is happening and imply that we're going to be seeing more and more of it. A-a-r-r-g-h! 

            • Re: Medicare: Inpatient or Outpatient?
              That's why the article is important to read. Forewarned is forearmed!
              Interestingly enough, I posted this to an AARP Medicare forum and the moderator got very huffy about it. Said "media distorts the truth" and "it isn't YOUR own personal experience". She deleted it, and I was fine with that - it's her forum, after all. But I thought it was odd, since supposedly the forum is about both experiences and information.
              Anyway, hope this might help some folks. So many things to be aware of when something bad happens, whether to oneself or a family member/friend. We really have to be informed consumers.
                • Re: Medicare: Inpatient or Outpatient?
                  I presently am employed as Case Manager in large hospital system and if a patient is changed from inpatient to Observation we are mandated to inform the patient and provide information explaining the differences.
                    • Re: Medicare: Inpatient or Outpatient?
                      lealou, I think it's more an issue that what people are told, or even given in writing, isn't always what they understand.
                      When the average person confronts the legal complexities of a medical issue, whether these are government programs or private insurer policies, it's difficult not to get 'snowed under' by all the details involved.
                      Remember that much of the time the family is dealing with a number of other issues caused by the medical situation, and a lot of information can be received, but missed.
                      This happened to us when my stepfather-in-law died. He had a Revocable Living Trust, and none of us fully understood the ramifications of this change as explained by the lawyer. It wasn't until several years later, when we went to another lawyer to have MIL's trust updated and create our own, that we found out we hadn't completely understood the first lawyer at all.
                      It wasn't her fault, either. She had told us, but we simply lacked the ability to place those changes into a logical whole picture. Now it seems so obvious to us...but at the time MIL's husband died, it just felt like a big muddle that all of us wanted over as soon as possible.