Sometimes Medicare will decide that a particular treatment or service is not covered and will deny a beneficiary’s claim. Many of these decisions are highly subjective and involve determining.
Learning of unexpected expenses related to “in-patient” vs. “observation” hospital status leaves many hospitalized patients and their families confused and upset. And, when they find out that a “three overnight stay” in the hospital did not count as a pre-condition of payment of care in a skilled nursing facility when rehab is needed, the related expenses can rapidly deplete hard earned savings. The Centers for Medicare and Medicaid Services (CMS) issued notice of proposed rulemaking published in the Federal Register on July 30, 2012, and is asking for public comment. Take the opportunity to share your experience with observation status and to recommend changes that you believe would improve access to medically necessary hospital and skilled nursing facility care!