In October post op day 110 was about the two midnight rule that had been postponed for the umpteenth time as CMS (center for medicare and Medicaid services) and congress haggled over its institution. Apparently the haggling continues and nothing has happened.
Hospitals have been retroactively penalized for treating patients as inpatient when CMS felt that was overkill ( poor choice of words) and the patient was only admitted to the hospital in order to justify higher reimbursement. CMS wanted to require the patient to have been an inpatient for two consecutive midnights to qualify for the inpatient status. Congress felt the interpretation of the rule was confusing. The fight was on.
And is still ongoing.
The American Hospital Association is suing the government over the bill. CMS has offered to reimburse disputed claims at 68 cents on the dollar. Hospitals are still struggling over how to properly treat the patient with the threat of financial penalties hanging over their heads if they err on the side of over action. And patients are still ultimately responsible for disputed charges.
So...be sure it is clear if you are being held in the hospital for treatment or observation. Even if your stay does span two midnights, unless you are classified as under treatment, you are not considered an inpatient. Treatment as an outpatient can make your charges higher, can disqualify you for post hospitalization nursing home care. The most recent deadline for implementation is the end of this month but why think it will happen then.
The bottom line is:
"In order to qualify for Medicare reimbursement under inpatient rates, the two-midnight rule requires that physicians deem the patient's condition as serious enough to require at least two overnight stays. Patients who aren't formally admitted may remain under outpatient or observation status--an action that may leave patients with high out-of-pocket expenses."
Hospitals have been retroactively penalized for treating patients as inpatient when CMS felt that was overkill ( poor choice of words) and the patient was only admitted to the hospital in order to justify higher reimbursement. CMS wanted to require the patient to have been an inpatient for two consecutive midnights to qualify for the inpatient status. Congress felt the interpretation of the rule was confusing. The fight was on.
And is still ongoing.
The American Hospital Association is suing the government over the bill. CMS has offered to reimburse disputed claims at 68 cents on the dollar. Hospitals are still struggling over how to properly treat the patient with the threat of financial penalties hanging over their heads if they err on the side of over action. And patients are still ultimately responsible for disputed charges.
So...be sure it is clear if you are being held in the hospital for treatment or observation. Even if your stay does span two midnights, unless you are classified as under treatment, you are not considered an inpatient. Treatment as an outpatient can make your charges higher, can disqualify you for post hospitalization nursing home care. The most recent deadline for implementation is the end of this month but why think it will happen then.
The bottom line is:
"In order to qualify for Medicare reimbursement under inpatient rates, the two-midnight rule requires that physicians deem the patient's condition as serious enough to require at least two overnight stays. Patients who aren't formally admitted may remain under outpatient or observation status--an action that may leave patients with high out-of-pocket expenses."
No comments:
Post a Comment