Patient Status Has An Effect On Medicare Coverage

Under federal law, it more difficult to obtain post-hospital medicare coverage. For a patient to qualify for post-hospital care under Medicare, the patient must spend 72 hours in the hospital. However, if the hospital classifies the patient as an out-patient, then the patient is not entitled to receive any benefits following his or her treatment in the hospital. This policy has become a great concern for the American Medical Association (AMA), who is urging the state to rescind the policy. However, the real problem with the policy is that it often leaves the patient unaware of the immense medical expense that he or she incurred as a result of their treatment. Therefore, the AMA has recommended several different solutions to solve some of the problems:

• First, hospitals need to gain consent from the patient’s acting physician before altering a patient’s status.
• Second, greater transparency is needed at hospitals that receive Medicare and Medicaid.
• Third, the policy for admitting claims and demands should now require a concurrence from a specialists in the field.
• Fourth, there should be a change to the status policy.
• Finally, there should be a stay on Medicare audit contractors from changing and reviewing patient’s statuses, until the policy is changed.

See Charles Fiegl, AMA Seeks Changes To Medicare Hospital Observation Policy, American Medical News, Apr. 16, 2012.

Special thanks to Jim Hillhouse (Professional Legal Marketing (PLM, Inc.)) for bringing this article to my attention.