At 7:30 in the morning George Matsoukas’ phone rang with urgent news about his 96-year-old mother, who had fallen and broken her pelvis two days earlier.
It was their family physician, with what seemed to him a bizarre and unreasonable demand: Matsoukas needed to come immediately to remove his frail mother from JFK Medical Center in Atlantis. Matsoukas, a retired community college instructor who lives in West Palm Beach, was baffled.
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Outpatient vs Inpatient
For Medicare beneficiaries, it matters. Here’s why:
- Inpatients have better coverage under Medicare Part A. There’s a one-time deductible of $1,184 for up to 60 days’ care.
- Outpatients’ bills are covered under Medicare Part B. Patients must pay both their deductible and 20 percent of doctors’ charges. They’ll probably also have to cover the hospital’s charges for medications.
- Medicare only pays its nursing home benefit following a “qualifying hospital stay.” That requires a three-day inpatient stay; any time spent in observation doesn’t count toward the three days. Plus, the day of discharge doesn’t count toward the three days.
*Note: Rules may differ for beneficiaries with a Medicare Advantage plan.
Source: Centers for Medicare & Medicaid Services.
ABOUT THIS ISSUE
Hospitals are classifying more Medicare patients’ stays as “observation” visits instead of inpatient admissions.
Medicare won’t pay nursing home costs if a patient wasn’t admitted.
As a result, consumers — particularly seniors — are being surprised with huge bills. But hospitals say aggressive audits have left them no choice.