Beware of the “Admitted for Observation” Billing Code
A daughter’s story:
“An ER doctor examined her, saw that she couldn’t move her leg, couldn’t really even hold her body upright and had trouble with her memory. He said he would admit her to the hospital’s observation unit to figure out what was going on. He mentioned she might need rehab care to get up and walking again.
He said he and the hospital “do all they can to be sure their patients’ care is covered.” I was reassured.
On the day they decided to release her, a social worker named Jay called to say the doctors were recommending she go to an inpatient rehab center — and then he said Medicare wouldn’t pay for it.
My mother was caught in an administrative wonderland where she slept at a hospital for four nights, but the paperwork said she was an inpatient only one of those nights. Medicare require people to spend three nights in a hospital before the federal program will pay for inpatient rehabilitative care.”
I have included this link to the story, originally aired on NPR, about how the hospital had to navigate the maze of Medicare rules regarding inpatient vs. outpatient.
Reminder: Medicare requires a patient to have been diagnosed with a condition to qualify for in-patient admission. The patient must have been a hospital inpatient for at least 3 consecutive days to receive coverage for rehabilitation in a skilled nursing facility (SNF) after hospital discharge.
Sources:
(i) https://www.npr.org/sections/health-shots/2018/04/20/583338114/how-medicares-conflicting-hospitalization-rules-cost-me-thousands-of-dollars
(ii) ma/article-abstract/1738447?redirect=true