May 22, 2012

Patient Rights: When you're in the hospital, ask if you've been admitted

Source: NYSUT Retiree Services

The next time you go to the hospital and receive care, make sure to ask one important question: "What is my status: Am I Admitted to the Hospital or am I under Observation?" The answer to this question can mean a difference of thousands of dollars and who pays for future care -you or your insurance company.

A new trend has been for hospitals to care for patients who are not admitted, but are deemed to be in "observation status." The use of observation status may be increasing because of new Medicare plans to reduce reimbursement rates for hospitals with high readmission rates. By putting patients in observation status, they are not counted as "admissions." Your care may be the same, but there is one important difference -and that's how the hospital gets paid by Medicare. If you are admitted Medicare Part A will pay, but if not, Medicare Part B pays.

The distinction is an important one since observation status can lead to a denial of coverage for any subsequent discharge to a skilled nursing facility. A three day hospital stay is required for Medicare to cover any skilled nursing care, and that means you must be admitted to the hospital not in observation status, for your nursing home care to be covered by Medicare. The Center for Medicare Advocacy recently filed a lawsuit against Medicare challenging the "observation status" that hospitals are using. The lawsuit charges that the observation status can lead to a denial of coverage when the patient needs skilled nursing care upon discharge. The Center for Medicare and Medicaid Services (CMS) reports that there has been a dramatic increase in the use of observation status by hospitals in the past few years. Many Medicare beneficiaries are not aware oftheir status unless they inquire, so we urge all persons to ask if they are formally being admitted to the hospital.

In general, it's important to know your rights as a hospital patient.

Patients are informed of these rights when admitted, but since that is often a time of high stress it is best to know your rights ahead of any hospital stay. The NYS Department of Health has a 40 page booklet describing those rights that is worth the read, in fact, StateWide was instrumental in passing the law that required the publication in order to empower patients. Copies can be printed from a link on StateWide's website

Medicare/Patients Rights Helpline (800) 333-4374