Medicare Section
Beneficiaries can appeal “admission status” that cost them thousands in health care costs
Congress passed a law in 2019 that requires hospitals to tell patients what status they are being treated under.
Nearly a decade ago, a group of Medicare beneficiaries sued the U.S. Department of Health and Human Services in what became a nationwide class action. Last week, in a ruling in that suit, U.S. District Judge Michael Shea of Connecticut said patients can appeal their hospital status if their doctor admitted them as a regular inpatient but the hospital later classified them as under observation.
Under current Medicare policy, if an enrollee who has been in the hospital needs to go to a skilled nursing facility for more care, Medicare will pay for those services only if the patient has spent at least three days in the hospital. (Officials at the Centers for Medicare and Medicaid Services have suspended that three-day rule during the COVID-19 pandemic.) But sometimes, Medicare patients who go into the hospital and think they have been admitted as inpatients are instead changed to what Medicare calls observation status, meaning they are considered outpatients even if they remain in the hospital for days.
Judge Shea's decision applies to all traditional Medicare (Part A and Part B) beneficiaries whose status was switched since Jan. 1, 2009, who spent at least three days in the hospital and who were enrolled in Medicare's Part A hospital benefit. If they win their appeal, most hospital expenses and any nursing home bills they paid will be reimbursed, as long as they satisfied any deductibles and copays
(Theresa’s comment: Most Medicare Advantage plans do not have the 3 day inpatient hospital requirement prior to a transfer to a nursing home or skilled nursing facility. This article would not apply to my Medicare Advantage clients. This is Original Medicare, Part A and Part B).
