Medicare Part A Archives - Steinlage Insurance Agency

How Hospital Outpatient status can cause trouble for you!

By Making the Most of your Medicare, Understanding Health Care Reform No Comments

Knowing the distinction between observation care and inpatient care (admitted patient) is important for seniors. If you have not been admitted to the hospital for at least three consecutive days (two midnights) you are not eligible for follow-up nursing home coverage and may have higher out-of-pocket expenses while in the hospital. Furthermore, drugs that you receive during observation care are not covered – you are charged full retail value of drug. Under the rules, Medicare picks up the whole tab for the first 20 days in an approved skilled nursing facility for rehab or other care, but only if someone has spent at least three full days (two midnights) in the hospital as an admitted patient. If instead a patient has been under observation — for all or part of that time — he or she is responsible for the entire cost of rehab. FAQ: How does this affect me…

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Hospital billing changes with Medicare

By Making the Most of your Medicare No Comments

With Medicare looking to control costs, a controversial billing practice is on the rise.  Seniors who spend days at a hospital without actually being admitted can be left with thousands of bills to pay, which are not covered by insurance. In more and more instances, a person enters a hospital under “observation,” rather than being admitted.  This is true even when a person stays multiple nights in a hospital bed, receiving similar care to their neighbors, and for conditions such as a broken pelvis or chest pains.  Because this person is under observation, rather than being admitted, Medicare is able to pay hospitals far less for comparable treatment.  The trigger occurs because Medicare pays under Part A for someone admitted and Part B for someone under observation.  Part B payments have been substantially reduced in recent years.  Compounding this issue, Medicare is using a growing army of auditors who use…

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