Under the current Medicare regime, those requiring inpatient care are covered under Medicare Part A, and those only needing outpatient care are covered under Part B. This difference in classification is important as outpatients can face higher coinsurance, drug, and nursing home costs. For inpatients, after a consecutive three-day stint in a hospital, Medicare covers 100% of skilled nursing costs for 20 days and the majority of total costs for up to 100 days. Medical will not cover these costs for outpatients or inpatients with a stay shorter than the three-day threshold. This has become increasingly problematic as hospitals have started classifying a growing number of patients as outpatients, even when they provide medical services for extended periods of time. These patients are then forced to pay for the entirety of their nursing care expenses. This status classification has previously not been an appealable issue, but this may change with a recent ruling by a federal judge in Connecticut.
See Paula Span, Under ‘Observation,’ Some Hospital Patients Face Big Bills, The New York Times, September 1, 2017.
Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.
