I want my clients who are eligible for Medicare (and their families) to understand that whenever they go to a hospital, it is important to know and to clarify their billing status. Hospitals are increasingly categorizing stays as for “observation” or “outpatient” even if the patient is in the hospital for several days. This is because hospitals have a large financial incentive to classify an individual as outpatient. (An outpatient stay is covered under Part B of Medicare. An inpatient stay is covered under Part A of Medicare.)
The rub for you is that, under the Medicare statute, an individual must have an inpatient stay in the hospital of at least three consecutive days, not counting the day of discharge, in order to meet Medicare criteria for coverage of post-acute care in a skilled nursing facility (SNF). A simpler way of saying this is that Medicare will only pay for “rehab” if the patient is being discharged from in-patient care. The bottom line for my clients is that, if you or your loved one is not “admitted” to the hospital in the first place, Medicare will not pay for “rehab.” It’s important to clarify this with the hospital!
HERE is a page with self-help resources if you find yourself being impacted by this issue personally. Additionally, the National Academy of Elder Law Attorneys (NAELA) is requesting your help in lobbying to eliminate this loophole that is being used to deprive patients of reimbursement for legitimate and cost saving health care measures. HERE is a link to a page on the web site of NAELA where you can learn more and sign on to support legislation designed to fight this technicality.
If you find yourself needing my assistance with an issue related to Medicare, feel free to contact me using the contact form below.