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April 3, 2017
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August 21, 2017

Important Medicare Case May Affect Patients Put on “Observation Status”

Original article from medicareadvocacy.org

Eighty- four year old North Carolina native Nancy Niemi was in the hospital for thirty-nine days earlier this year as doctors tried to stabilize her blood pressure and address other serious complications. During her stay, the hospital categorized her as an outpatient on “observational status.” As a result, she lacked the three day inpatient stay Medicare requires to cover the cost of a nursing home. Ms. Niemi is just one example of over nine-hundred thousand Medicare beneficiaries  placed on “observational status” since 2009.

Medicare patients who visit the hospital need to be aware that although they may be in a room and be receiving treatment, they may have been put on “observation status” rather than having been admitted to the hospital. Hospitals treat patients on “observation status”  the exact same as a regular inpatient but Medicare will not cover.

The difference can be critical as far as Medicare paying for services both in the hospital and later in a nursing home.  If the patient requires rehabilitation or long term care placement, Medicare may not pay for any of the care. A recent court decision has allowed patients placed on observation status to bring a claim to have their unreimbursed care covered by Medicare. This is a step in the right direction and we will eagerly watch the outcome as the case progresses.