To: The United States House of Representatives and The United States Senate
Observation Stays: “Current Hospital Issues in the Medicare Program”
The Rhode Island Alliance for Retired Americans Alliance is very concerned about the growing practice of hospitals keeping patients under “observation status”, rather than admitting them as inpatients. We are hearing from more and more of our members who are being affected by the policy.
Why is this important?
Observation status is a designation used by hospitals to bill Medicare. As a result of this designation, more and more seniors are experiencing difficulties getting Medicare coverage for admission to skilled nursing facility (SNF), along with other billing issues. In fact, Medicare estimates show that 1.6 million seniors were placed in “observation status” during a hospital stay in 2011. This is a 69 percent increase over the previous 5 years. Medicare beneficiaries who have played by the rules and contributed their entire working lives to the program so that they can have peace of mind and be covered for medically necessary services should not find themselves incurring unexpected costs and having to hire attorneys to get the coverage they already paid for.
One solution that would solve this situation is for Congress to pass the bipartisan bill Improving Access to Medicare Coverage Act of 2013, S.569 and H.R. 1179, introduced by Senators Sherrod Brown and Susan Collins and Representatives Joe Courtney and Tom Latham, which would amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” towards the three-day hospital stay requirement for skilled nursing care. The measure would also establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after January 1, 2013.
One solution that would solve this situation is for Congress to pass the bipartisan bill Improving Access to Medicare Coverage Act of 2013, S.569 and H.R. 1179, introduced by Senators Sherrod Brown and Susan Collins and Representatives Joe Courtney and Tom Latham, which would amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” towards the three-day hospital stay requirement for skilled nursing care. The measure would also establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after January 1, 2013.