CMS Continues to Insist Hospital INpatients are OutPatients

July 12, 2013 at 6:55 pm 2 comments

When it wrote the Medicare law, Congress called Medicare Part A “Hospital Insurance” and Part B “Supplemental Medical Insurance.”  Part A is intended to pay for inpatient hospital care.  It is a charade to consider people who stay IN the hospital for more than 24 hours “outpatients,” and pay for their care under Part B. This not only conflicts with the Medicare law and Congressional intent, it also harms the older and disabled people – and their families – who depend upon Medicare and for whom the law was written. They lose their right to Part A hospital coverage, are often left with hospital bills they would not have if they were properly admitted, and completely lose their ability to obtain Medicare coverage for post-hospital nursing home care.  CMS’s insistence on continuing this policy places hospital payment mechanisms over the interests and rights of older and disabled people.

Entry filed under: Observation, Uncategorized. Tags: .

Stop Bleeding Medicare By Wasting Money on Private Plans Alternative Recommendations from Long Term Care Commission Members, Including the Center’s Judith Stein

2 Comments Add your own

  • 1. Kathi Barone  |  October 9, 2013 at 5:49 am

    Last week, my 85 year old father began to experience sudden weakness in his legs and severe pain in his lower back. His PCP couldn’t fit him in but recommended the ER if he was in a lot of pain – he was, so Friday afternoon, my brother took him to the ER of the nearest hospital. They wanted to check him out with an MRI, but their machine was not available. The hospital “admitted” him – or so we thought . . .

    Dad was moved to the 3rd floor and into a private room. The MRI still wasn’t available on Saturday so he continued to stay in the hospital, receiving what we believed was inpatient care. Sunday evening they were finally able to do the MRI, but the doctor had already left and we needed to wait until Monday for the results.

    GOOD news – The physician who reviewed the MRI stated that there was no sign of fracture in his spine, so no surgery would be required. There appeared to be some kind of compression that needs to be treated with physical therapy and medication. The doctor said they would discharge him to a skilled nursing facility.

    BAD news. The social worker at the hospital informed us that because my father was in “outpatient status” from Friday through Monday, he wasn’t eligible for the Medicare Plan B SNF benefit, which requires 3 days of inpatient care in a hospital before the patient can be admitted to the SNF. The hospital agreed that it was not safe to discharge my father to go home since he couldn’t walk and was in even more pain than when he arrived in the ER, so they let my father stay for yet another night.

    I met with the hospital staff this morning (physician, social worker, physical therapist) to beg them to recognize my father’s stay as inpatient so that he could be discharged to a SNF, but, while they expressed sympathy for our situation, they insisted that the Medicare criteria for inpatient status made it impossible for them to help us.

    I met with my brother and father and we tried to consider all possible options – from getting a reverse mortgage on Dad’s little townhouse to having us each chip in as much as we can afford to help pay privately for the SNF. I also asked the physician for a second opinion on the MRI. At 5pm today the doctor agreed that my father should be transferred to another hospital to be assessed by a neurosurgeon. At the second hospital, the admitting physician still could not promise that my father was in inpatient status – they won’t be able to tell us until tomorrow after the neurosurgeon has evaluated my father.

    I don’t know what we’re going to do if this hospital won’t admit him as an inpatient! The point of this long rambling message (besides allow me to vent my frustration!) is to thank Judith Stein for this blog entry and to ask CMA to continue to fight this cause.

    • 2. Judith Stein  |  June 26, 2015 at 4:02 pm

      This is dreadful and unjust. I am terribly sorry. we are doing all we can to resolve this injustice.Contact your Senators and Congressperson and ask them to support the bills in Congress to count all time spent in the hospital. Rep. Joe Courtney is the main contact.


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Health Policy Expertise

We provide effective, innovative opportunities to impact federal Medicare and health care policies and legislation in order to advance fair access to Medicare and quality health care.

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July 2013


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