If it did, you are not alone. Over the last several years, an increasing number of elder patients have been paying more for their hospital stays than they should have under Medicare. That's because of the way hospitals are now classifying their Medicare patients.
According to a recent study by Brown University, over the last several years there has been a 25 percent increase in hospitals classifying Medicare patients as "outpatients" under "observation" instead of being classified as "inpatients," even though they may be inpatients in everything but name.Has this happened to you? If it has, call an experienced attorney at the Westchester, New York, elder care law firm of Enea, Scanlan & Sirignano, LLP: 914-269-2367.
Why Hospitals Are Doing This
Although Medicare reimburses hospitals at a lower rate for an outpatient observation versus inpatient, it appears Medicare rules are still driving hospitals' decisions. Hospitals are classifying more patients as outpatients under observation to avoid:
• Medicare penalties should the patient be readmitted
• Costly audits by Medicare of their admission claims
• Reimbursing Medicare for the costs of services rendered should Medicare find the hospital incorrectly classified the patient as an inpatient
This may be fine for the hospital, but not so for the patient.
What This Means To You
For you as the patient, this means greater out-of-pocket costs, since you will be using Medicare Part B to pay for the stay, instead of Medicare Part A.
Need Rehabilitation? It Will Cost You Even More.
Should you then be discharged from the hospital to a skilled nursing or rehabilitation facility, you will be paying even more out-of-pocket costs.
|Days In Skilled Nursing Or Rehabilitation||"Outpatient": What The Patient Pays Per Day||"Inpatient": What The Patient Pays Per Day|
|Days 1 through Day 20||$0||$369 on average|
|Days 21 through 100||$144.50||$369 on average|
What Is Being Done Legislatively
To address this classification issue, in March 2013, Rep. Joe Courtney (D-Conn), introduced H.R. 1179: Improving Access to Medicare Coverage Act of 2013. However, as of this writing, the bill is stalled in committee.
What You Should Do Now
If you are admitted to a hospital, you and your physician should be vigilant, making sure you are properly classified. You can also contact the experienced lawyers at the White Plains, New York, elder care law firm of Enea, Scanlan & Sirignano, LLP. Locally, call 914-269-2367 and toll free call 800-724-1327. If you prefer, you may reach us by completing this online form.