Medicare’s Stringent Requirements For Post Hospital Care

AARP reported in an article dated October, 2012 that an elderly patient, Jean Arnua, spent five days in the hospital for a fractured spine following an emergency room visit.  Neither she nor her family was aware that Jean had never been “formally” admitted to the hospital.  The stay was recorded as “observation” and not “in patient” by the hospital.  Once discharged, the family wanted to place Jean in a Skilled Nursing Facility for post hospital rehabilitation care.  This is when they discovered she was never fully admitted to the hospital.  The financial consequences were staggering.

Medicare will only pay for post hospital care in a Skilled Nursing Facility after the patient has been an “in patient” at a hospital for three consecutive days.  They will pay for the full twenty days in a Skilled Nursing Facility if the patient meets this requirement.  If they do not, the patient is financially responsible for the entire bill at the Skilled Nursing Facility.

Another example is Amau, an 84 year old widow, who received a bill for $3,900 from a Skilled Nursing Facility for a two week stay.  Medicare did not cover her stay because she did not meet the three day “in patient” hospital stay requirement.

Are elderly patients being financially exploited?  Experts believe hospitals are using the observation status in order to protect themselves against new policies that penalize hospitals for unnecessary admissions and frequent readmissions of the same patient.  Medicare is auditing hospitals where they believe the hospital is admitting patients unnecessarily.  Elderly patient are caught in the crossfire between hospital administration and Medicare policies.  Due to these policies, elderly patients have suffered negative health consequences and substantial financial loss.

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