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Know Your Hospital Status to Prevent Medicare Confusion

Many people who wind up in a nursing home are transferred there after a hospital stay. But an article in today’s The Washington Post points out a technicality that could block your ability to have Medicare cover the cost of  your nursing home stay.

Basically, everyone in the hospital is categorized as being in either “for observation” or as a regular “inpatient.” Here’s the tricky part:

Even if you are admitted as an inpatient, the hospital can switch you to observation status; in that case, the hospital is required to notify you.

If you do not have three consecutive days of hospitalization as an inpatient — excluding the day of discharge — Medicare will not cover a subsequent stay in a nursing home. For those who do qualify, Medicare pays for up to 100 days of rehabilitation or skilled nursing care.    [from The Washington Post article, emphasis added]

Although you can’t force the hospital to change your status from “observation” to “inpatient,” you can ask what your status is, and why. You can also talk with your personal physician, who can request (but not force) a status change.

If you are admitted to a nursing home without the required three days as an inpatient, there are still steps you can take to try to get Medicare to cover your costs.

  1. When you enter the nursing home, ask to have them bill Medicare for your care.  If Medicare denies the claim, you can appeal the decision.
  2. If the nursing home won’t bill Medicare, then you can complete a form called a “Notice of Exclusions from Medicare Benefits: Skilled Nursing Facility” (click the form name for an online copy of the form). The nursing home won’t bill you while you wait for a response from the government (and you know how long it can take to hear from a government agency).

If Medicare does not pay for your costs, you will be responsible, so know your rights…and continue to appeal any denial until you have no more options. If you need help, contact a local Estate/Medicare lawyer, who can usually provide technical assistance in these types of matters.

Sources of Information

The Washington Post

www.medicare.gov

HensonFuerst attorneys (www.hensonfuerst.com)

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