FAQ: Hospital Observation Care Can Be Costly For Medicare Patients

I have addressed this issue with many of my Medicare clients, so that they can ask the right questions regarding their status if they go to a hospital and are told to stay overnight.  A variety of difficulties can arise when your status is considered to be "outpatient". 

This becomes especially acute when someone is on a Medicare Advantage plan, as most of those plans in recent years have classified all "outpatient services" as requiring 20% coinsurance from the client.  If held in an "observation" mode in a hospital, that means the patient would be billed 20% of each charge incurred while in the hospital's care.  This can lead to thousands of dollars of coinsurance that the patient may not understand he or she owes.

Just because you're in a bed, and staying overnight in the hospital does not necessarily mean that you've been admitted.

Here's a good Frequently Asked Questions article from the Kaiser foundation that explains this phenomenon in more detail:

Medicare Observation Care FAQ

Home is where the money is for Medicare Advantage plans

Many of my Medicare clients have questioned the "home visits" offered by Medicare Advantage plans.  Some clients who have had the experience, thought it worked out well, and they appreciated the ability to talk with a nurse practitioner directly.  Other clients were hesitant to have someone come into their home, so they declined the visits.

All of the Medicare Advantage plans that I represent, currently offer the opportunity for a home visit to the members of the plan.  Whether you accept or decline, is up to you.

This article explains more about the home visits and how the data may be used.  It's worth a look.

Here's the full article . . . .

CMS Proposal Would Penalize More Than 2600 Hospitals

This article points out some of the problems with penalizing hospitals for readmission of patients. One thing I've seen my clients experience personally is the phenomenon of being "held for observation" as an outpatient resulting in the Medicare patient being stuck with 20% outpatient coinsurance for everything that happens - which can be thousands of dollars in billing.  In their zeal to cut back on "short stays" in hospitals and "readmissions" -hospitals are hesitant to admit anyone as an inpatient.  As the article points out, they aren't clear on what parameters they are being measured on in the first place - they find out when they get the penalty.

You can read the complete article here:

Researcher Says CMS Proposal Would Penalize More Than 2600 Hospitals