Former Medicare chief Dr. Donald Berwick said Obama administration officials should abandon a rule that is leaving many older Americans without coverage for expensive rehabilitation care after they leave the hospital. The Medicare rule requires recipients to be admitted as a hospital inpatient for at least three days before the federal health insurance program for seniors and the disabled will pay for follow-up nursing home care. The problem is that an increasing number of patients are spending days in the hospital under “observation’’ status, often without realizing they were never officially admitted. “The patient ends up holding the bag and…
As part of the annual update to inpatient hospital reimbursement under the Medicare program, CMS is again considering observation status. This time, CMS is proposing "a time-based presumption of medical necessity for hospital inpatient services based on the beneficiary's length of stay" (78 Fed. Reg. 27486, 47644 (May 10, 2013)). Under the proposed rules, Medicare would presume that an individual is an inpatient if the physician documents that the patient requires more than two midnights in the hospital following an inpatient admission. The "starting point for this time-based instruction would be when the beneficiary is moved from any outpatient area…
For the first time, the federal government has publicly announced what hospitals bill Medicare for the 100 most common diagnoses and treatments. The information shows hospitals across the country — and across Alaska — bill dramatically different prices for the same things. Hospital veteran Rick Davis, the CEO of Central Peninsula General Hospital in Soldotna, was eager to review the on hospital charges as soon as it was out. "It's going to create ripples across the nation, really, on pricing," he says. "It does show some pretty big disparities between hospitals." For example, Alaska Regional in Anchorage charges Medicare $46,252…
Hospital discharge personnel must tell you what level of care is required after you leave the hospital. Also, you need to know what medications and therapies should be taken and when. Suppose family members are told that 24-hour-a-day supervision is needed; then you should ask if this means assisted living or some other interpretation. Additionally, if medications change when in the hospital, find out what should be taken and when. You should control your own placement. Before you leave the hospital, you or your family should know where you want to go. Do not depend exclusively on someone inside the…
“Up to 100 days” of coverage for rehabilitation does not guarantee 100 days. Up to 100 days of coverage rarely means 100 days. Often insurers discontinue therapy benefits after 2 to 8 weeks. They might say the patient has “plateaued” in treatment, not showing measurable improvement on a weekly basis. However the correct legal standard is aslong as the patient shows improvement or the therapy prevents deterioration. Many times therapy ends before it should. When Medicare therapy ends, if the resident stays in rehab or in a nursing home, then she must pay privately or, if assets are low enough,…
In order to be eligible for Medicare coverage, the health services used must be both reasonable and necessary in the treatment of an illness or injury.
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