You Can Now Appeal Your Hospital Observation Status As A Medicare Beneficiary 

Hospitals use the term “observation status” when billing Medicare. Unfortunately, it may be detrimental to patients in the hospital who count on Medicare for their healthcare. Even for a few days or overnight, people treated in hospitals may discover they were not admitted as inpatients.

When hospital patients are assigned Observation Status, they may well be charged for healthcare services that Medicare typically covers if they had been admitted as inpatients. For example, patients can be billed for their drugs. As a result, if someone needs to travel to the hospital, they may wish to bring their meds.

Patients will also be unable to acquire Medicare coverage if they require nursing home care following their hospital stay. Medicare coverage only applies to nursing home care for people who have had a 3-day inpatient hospital stay – observation status does not count.

Medicare Part B covers outpatient observation status, while Part A covers inpatient hospital stays. If they are designated as Observation Status, Medicare participants enrolled in Medicare Part A (but not Medicare Part B) will have to pay for their entire hospital bill. 

What is the significance of this?

If you visit the hospital, you’ll be admitted as an inpatient, implying that Part A Medicare covers any service you receive. You can also be placed on “observation status,” which means your expenses will be reimbursed by Medicare Part B.

Now, you may be wondering if you can find out your condition before coming to the hospital. This, according to Oh, isn’t quite possible.

This creates confusion and is a big problem because some people don’t know their status or assume they’re covered under Part A while covered under Medicare Part B due to their observation status. These two halves have differing cost-sharing outcomes, which could spark a dispute.

There have been attempts to address this, such as the Notice Act. The hospital must inform patients of their condition under this provision. There’s also the Two-Midnight Rule, which states that a patient is deemed inpatient if they stay in the hospital for two midnights (and therefore covered by Medicare Part A). Even if a person stays over two midnights, they may be under surveillance status.

Medicare patients can now appeal their admission classification, whether admitted as an inpatient or as a patient under observation. People can start the process as soon as they receive their hospital bills.

The Part B deductible will be the most affected if Medigap covers you. The majority of Medigap insurance would cover the remaining costs. If you have Part A, Medigap will cover the difference.

Contact Information:
Email: [email protected]
Phone: 9568933225

Bio:
Rick Viader is a Federal Retirement Consultant that uses proven strategies to help federal employees achieve their financial goals and make sure they receive all the benefits they worked so hard to achieve.

In helping federal employees, Rick has seen the need to offer retirement plan coaching where Human Resources departments either could not or were not able to assist. For almost 14 years, Rick has specialized in using federal government benefits and retirement systems to maximize retirement incomes.

His goals are to guide federal employees to achieve their financial goals while maximizing their retirement incomes.