Apr 252024
Currently, Medicare beneficiaries who are not officially admitted to a hospital may be classified under “Observation Status,” which is treated as an outpatient procedure for billing purposes. Unfortunately, the common practice of placing a beneficiary on “observation status” can have significant financial consequences for Medicare beneficiaries, since Medicare Part A and its related coverage rules only apply to actual inpatient care admissions. This may lead patients, many who are extremely sick and may need skill nursing care (SNF) to spend many days in the hospital and be charged for services that Medicare would have otherwise paid had they been admitted. Furthermore, hospitals have up to one year to retroactively change admission status to observation, leading unsuspecting beneficiaries with thousands of dollars in bills for SNF care they believed would be covered by Medicare.
Bipartisan legislation is pending in the U.S. House of Representatives that addresses Medicare’s “two midnight” policy. Representatives Joe Courtney (D-CT), Glenn Thompson (R-PA), Suzan DelBene (D-WA), and Ron Estes (R-KS) introduced H.R. 5138 which would allow observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of a skilled nursing facility (SNF).
Please contact your federal legislators and urge them to co-sponsor bipartisan legislation that would address this important issue!