Clear up confusion surrounding observation services and admission into hospitals/ Your rights?

Kaiser Health News – Susan Jaffe

How do I know what my hospital status is?  Ask your doctor or other hospital officials if you are in the hospital for observation or as a regular inpatient. If you are an observation patient, ask why. Even if you are admitted as an inpatient, the hospital can switch you to observation status; in that case, the hospital is required to notify you. If you do not have three consecutive days of hospitalization as an inpatient — excluding the day of discharge — Medicare will not cover a subsequent stay in a nursing home. For those who do qualify, Medicare pays for up to 100 days of rehabilitation or skilled nursing care.

How long can the hospital keep me for observation? Medicare expects patients to remain in observation status for no more than 24 to 48 hours. But there are no rules limiting the time; some patients spend several days in observation.

What can I do if the hospital won’t change my observation status to inpatient?  “You cannot directly appeal the hospital’s determination that you are or were an observation patient,” says Ellen Griffith, a Medicare spokeswoman.If you think you should be considered an inpatient, ask your personal physician to call the hospital and request a change in status, although your doctor cannot mandate this. If that is not successful, there are other steps you can take.

If the nursing home or hospital says Medicare won’t cover my nursing home stay, what can I do?  Ask the nursing home to bill Medicare when you enter the facility, Griffith says. Medicare will deny the claim if you do not have the required three inpatient days. The next step is to appeal that decision to the Medicare billing contractor, which will probably also deny your request. You can then appeal that decision.

×