Observation or inpatient? Patients should check as status has major Medicare ramifications

From the Carroll County Times:

Medicare payment changes for observation patients several years ago were followed by lawsuits arguing that patients were held too long in the status and/or should have been admitted as inpatients. Congressional briefings followed.

The Centers for Medicare and Medicaid Services (CMS) then adopted the “two-midnight rule” for insurance coverage: Patients whose doctors expect them to stay in the hospital through two midnights should be admitted as inpatients, while those expected to stay for shorter periods should be kept in observation.

At Carroll and many other hospitals, observation care is typically overseen by a group of hospitalist physicians rather than patients’ primary care physicians, Reid said. The reason is that observation patients should be checked frequently, she said.

“How would a physician who is running a busy practice … see a patient in observation every few hours?” Reid said. “It would be really difficult for them to be in the hospital and [also] taking care of patients in their practice.”

Patients who learn they are on observation status while in the hospital can ask the doctors to admit them as inpatients. Winning Medicare coverage by appealing after leaving the hospital is increasingly difficult, according to the Center for Medicare Advocacy (www.medicareadvocacy.org/medicare-info/observation-status).

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