Due to a growing number of seniors having to unexpectedly having to pay
for post-acute care, Medicare has launched a pilot project to test whether
relaxing its hospital payment rules could help beneficiaries.
The issue revolves around patient classification. Under
Medicare rules, a beneficiary must be in a hospital for at least three days as
an inpatient to qualify for follow-up care Medicare coverage. However, even
after spending several days in a hospital, some patients are classified as
observation patients, which is an outpatient service. Additionally, observation
patients generally have higher co-payments and they can be billed any amount
for routine drugs they may need. This may all come as a surprise since
Hospitals don’t have to tell patients they are in observation care.
Currently, if Medicare determines that a hospital has billed
it for inpatient treatment of a patient who should have received observation
services, the facility may lose its entire payment. This is believed
to be causing
hospitals to put too many people in observation care that should be inpatients.
Under the pilot program, 380 Hospitals will be able to rebill Medicare for
observation services of patients whose inpatient care are rejected. Medicare officials hope that this will take
some pressure off of hospitals and grant beneficiaries, who need follow up care, access
to the necessary services.
