Health & Wellness

MEDICARE ALERT: OBSERVATION CARE is costing Medicare patients thousands of dollars. Patients who require rehabilitation after an accident or surgery must spend three consecutive days in the hospital as a medical patient in order to receive Medicare coverage for nursing home care during rehab.

Hospitals are keeping patients for three days after treatment for the injury but not as medical care. Instead, it is observation care. Observation care is not considered medical care but outpatient care; therefore, rehabilitation costs in a nursing home or rehab facility become private pay. Patients are often required to meet these payments before the patient is admitted.

An argument will be heard in federal court in Hartford, Connecticut for a lawsuit seeking to have the observation clause removed from the Medicare requirements. This lawsuit is based on the experiences of Lois Frarie who required surgery after she broke her elbow and pelvis. After spending four days in the hospital following surgery she went into a nursing facility for rehabilitation.

Mrs. Frarie was required to pay over $19,000 for rehab care because two of the four days she was hospitalized after her surgery were considered observation care, not medical treatment, making her Medicare ineligible for nursing home rehabilitation.

Kaiser Health News reports that seniors often find it difficult to get information from the hospital regarding the type of care they are receiving and there is little that Medicare billing personnel can do to help. For more information on this issue go to Kaiserhealthnews.org.

Reported by: Susan Jaffe, Kaiser Health News

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