Read this. This is an important concept to understand. Demand to be formally admitted, given a specific treatment & diagnosis and either go home or be kept for 3 days.
Thank you for info. I already knew about inpatient/outpatient care, but this reinforced what I knew. My question is. How can you insist that you be admitted? Can they physically restrain you?
Try to insist on a diagnosis and admission for it. If you keep insisting they are more likely to do it, doesn't mean they will but keep trying. Ask questions like why observation ONLY is needed, what's the diagnosis and plan etc. They can't force you to stay for observation or any reason except for mental issues. Anyone can leave a hospital at any time. They can't physically restrain you unless you are a danger to yourself or others...usually a mental impairment issue. If you are in the hospital and pulling out breathing tubes or IVs they can restrain your arms but the laws are very strict on how they do this.
This is an old thread but it turns out Obama signed a new law last November that is just taking effect to protect against not knowing this. Hospitals are now required to tell you if you are being kept for observation status.
After discharge you would naturally be an OP. But if you're saying that they changed your prior inpatient status saying it had been outpatient all along then yes it could protect you in a round about way. I don't think the law stops them from making you an OP, but when they do they have to tell you you are an OP. So theoretically if they had told you that you were an IP, then a sneaky UR person would not be able to change it. Some of the UR people are contracted and they make their money when they change the status from IP to OP. Medicare pays them to review the records and determine IP/OP status. If they decide it was actually an outpatient visit, then they get a percentage of the money Medicare saves. I guess the bottom line here is get it in writing. If they tell, you based on the new law, that you are an IP make sure you get it in writing.
Again I'm returning to this old thread but the issue came to my mind again when I read that Boswell will expand their emergency room. I read that one of the items for expansion will include an area with more observation status beds...which makes you an outpatient. Be aware when this happens that the hospital will have even more reason to place you on observation. Part B will pay for the observation stay, however, Medicare will not pay if you are transferred to a nursing home (I assume a "rehab facility" as well). In order for Medicare to pay the nursing home, you need to have the status of Inpatient and stay for 3 days. The law now requires them to tell you that you are outpatient/observation status. One way or the other, be aware of your inpatient/outpatient/observation only status and make decision appropriately. If not, you will end up with a large bill. Here is a link to a Medicare Advocacy group that explains how you might handle the situation. They explain the details about the issue and they offer this outpatient Self-Help Packet.
That explains the reason they are building those observation beds. They were found to have admitted people as inpatient, when they could have been outpatient, and charging Medicare more money. Fined 18 million and monitoring for 5 years. Some people might look at this and say Banner was trying to cheat Medicare. I'm not so sure about that. Maybe they were just trying to admit people like they should have been. Knowing about this observation status loophole, Medicare might really be the ass in this story. A former employee was the whistleblower on this. Under the whistleblower provisions of the False Claims Act, private citizens can bring lawsuits on behalf of the United States and obtain a portion of the government’s recovery. She will receive roughly $3.3 million.
Most of this is over my head, but let me add this tidbit: At one point, Boswell Hospital owned the rehab center a block away. I know this because mom went there after her stroke. She referred to it as the prison. Suffice to say, she hated it there. I suspect rehab units are almost always universally disliked due to them pushing you to get better. Don't know if Banner bought that along with the Hospital but i would be stunned if they didn't. Only matters given the questions raised above relative to where you are moved to from the emergency room.
The other problem with this fraud charge is now it will be very difficult for any Medicare patient at a Banner hospital to insist on an inpatient vs outpatient status. Yes, Banner had to pay, but they are not the only ones who will feel the brunt of this decision.
Not to long ago a friend of mine was refused inpatient admittance. She got dressed and left! Would the hospital have been responsible if she ultimately had problems due to non-admittance? She eventually died but not due to above problem. Can you demand to be admitted as inpatient?
If you think you should be an impatient and they deny you, you will need to fight it with Medicare. But it won't be easy. The advocacy group I linked to has information about that. Watch this women's video of her problem with it. If you leave against medical advise (AMA) the hospital is not at fault for anything except what they did for you while you were in their care. But if you have part B Medicare, you don't need to leave...stay under observation as an outpatient. From what I understand part B will pay for observation. Be care about the medication and supplies they use though...some might not be covered. Ask about everything. If you have Part D that should pay for the outpatient medicine (I'm not 100% certain, but I think they should since they pay for other outpatient meds people take everyday). The problem will arise if they say that they are transferring you to a nursing facility/rehab and you were never admitted, or did not stay for 3 nights as an inpatient. That is when you might need to go home. If you can. That's when the bill will start. You are not leaving AMA at that point because they are discharging you, you are refusing a transfer based on the inability to pay. I would never sign an AMA paper. They will take that into court. Just tell them why you are going to leave and go. They will chart it, but it's your word against theirs about the reason. I'm not an expert on this subject...few people are because Medicare payment is complicated...I'm trying to learn it as well. There is not even a written consensus on what determines outpatient vs inpatient. The bottom line is....ask a lot of questions about what is covered and what is not. I know some work is being done to overturn this 3 day rule and the outpatient issue. But since the current administration has plans to cut the Medicare budget, I don't see that as a likely issue to pass in beneficiaries favor. If you hear anything about it though, always remember to speak up and vote on it if you can. Or call the representatives, senators etc.
Part A pays when you are in a hospital and that is free. Part B pays for doctor visits/outpatient care. That's optional but it costs money depending on your income. It should be deducted from your social security check automatically. Part D is for medications and also optional. Maybe someone here can tell you what it looks like on your social security statement. I don't have them yet. Or if you have a Medicare advantage plan that is everything in one, without all the separate parts.
We've got the Blue Cross/Blue Shield Advantage Plan which is an additional $35 each plus our Medicare deduction. We're very happy with the plan as we could keep all our local doctors and very low/no co-pays.
Yes, I see that there is a medicare deduction from my SS. I have a card with shows Both Part A & Part B. You probably know that new Medicare cards are being sent. Arizona is next to receive them. Watch for it. I have had BCBS Advantage Plan II for several years. Originally it was $O/month. Then each year cost went up. Now it is $35. I have been happy with the plan, and I did check many. Copays have gone up and down over the years but are reasonable. I am fortunate to have a BCBS office nearby (La Ronde Circle) and they are very helpful. Also, they often have free seminars on a variety of subjects.
