[...]Classification of the patient as being “under observation” can result in thousands of dollars of additional costs to a patient requiring skilled care and/or rehabilitative services...
Westchester, NY (PRWEB) November 21, 2012
Over the last three years, hospitalized Medicare patients classified as an “outpatient under observation” rather than being formally admitted as an “inpatient” has jumped twenty-five (25%) percent according to a recent study conducted by Brown University. Westchester attorney and NY State Bar Association Elder Law Chairman Anthony J. Enea, an expert on Medicare, can attest to the growing frequency of this trend as he witnesses many of his clients having to personally pay for the costs of their rehabilitation in a skilled nursing care facility rather than said costs being paid for by Medicare.
Anthony J. Enea, Esq. is the managing member of Enea, Scanlan & Sirignano, LLP (of White Plains). In addition to his role in the NY State Bar Association, Enea is a former President and a Founding Member of the New York Chapter of the National Academy of Elder Law Attorneys (NAELA). He is also a member of the Council of Advanced Practitioners of NAELA, a former President of the Westchester County Bar Association, Vice President of the Westchester County Bar Foundation, and Vice President of the Columbian Lawyers Association of Westchester County.
While it is not unusual for a hospital to classify a patient in their Emergency Department to be “under observation” rather than an “inpatient” that has been formally admitted, Enea points out that it appears this is being done by the hospitals in order to avoid penalties being imposed by Medicare as a result of the re-admission of the patient, and to avoid costly audits by Medicare of their admission claims. As a result, the Medicare patient’s hospital stay is covered by Medicare Part B rather than Part A, which unfortunately results in the patient having more out of pocket costs.
“Additional costs to seniors are significantly compounded if the senior needs to be discharged from the hospital to a skilled nursing facility and/or a rehabilitation facility,” explains Enea. “If the hospital patient has been classified as an “inpatient” while hospitalized and has spent three nights in the hospital, then upon their discharge from the hospital to a skilled nursing and/or rehabilitation facility, his or her stay in said facility would be covered in full for the first 20 days.”
Medicare in New York will cover all expenses excluding $144.50 per day from day 21 to day 100, as long as skilled nursing and/or rehabilitation services are required by the patient. With the average cost being $369.00 per day in a skilled nursing and/or rehabilitative facility, it is obvious that the classification of the patient as being “under observation” can result in thousands of dollars of additional costs to a patient requiring skilled care and/or rehabilitative services upon his or her discharge from the hospital.
Enea states that Medicare’s pressure upon the hospitals to classify a patient as “under observation” stems predominantly from the fact that the reimbursement to the hospital for the patient in “observation” status is one-third of what it is for an “inpatient.” This is a significant financial consideration for both Medicare and the hospital. The pressure upon the hospital to make the determination that the patient is “under observation” is further complicated by the fact that if Medicare determines the hospital incorrectly classified the patient as an “inpatient” rather than “under observation,” the hospital will be on the hook for the cost of the services they rendered to the Medicare patient.
“The hospital is not in an enviable position,” said Enea. “One can only surmise that this will become even more perilous for hospitals and seniors once the Patient Protection and Affordable Care Act, also known as Obamacare, are fully implemented.”
As of November 2011, there has been federal litigation pending by the Center for Medicare Advocacy and the National Senior Citizens Law Center to end these coverage methods. In the meantime, it is crucial that Medicare recipients be vigilant as to the status of their admission, and with the help of their physicians, insist that they be classified as an “inpatient.” This is of particular importance if the senior will require skilled nursing and or rehabilitative services upon discharge.
To contact Anthony J. Enea, call 914-948-1500 or visit http://www.esslawfirm.com.
About Anthony J. Enea, Esq.
Anthony J. Enea, Esq. is the managing member of the firm of Enea, Scanlan & Sirignano, LLP of White Plains, New York. (http://www.esslawfirm.com). Mr. Enea is the Chair of the Elder Law Section of the New York State Bar Association. Mr. Enea is a Past President and a Founding Member of the New York Chapter of the National Academy of Elder Law Attorneys (NAELA). He is also a member of the Council of Advanced Practitioners of NAELA. Mr. Enea is a Past President of the Westchester County Bar Association. Mr. Enea is the Vice President of the Westchester County Bar Foundation. Mr. Enea is a Vice President of the Columbian Lawyers Association of Westchester County. Mr. Enea focuses his practice on Elder Law, Guardianships, Medicaid Planning and Applications, Wills Trusts and Estates.