Two Midnights, One New Challenge

This report stated: “Medicare beneficiaries had 1.5 million (limited?) observation stays in 2012; an additional 1.4 million long outpatient stays, and 1.1 million short inpatient stays”. Beneficiaries had over 600,000 hospital stays that lasted 3 nights or more but did not qualify them for SNF services.” Clearly a lot of money is on the table here. The report also noted wide variation and inconsistency in hospitals’ use of inpatient and observation/outpatient designation for similar diagnostic groupings. According to the OIG, many beneficiaries treated with observation stays incurred huge bills from SNFs because they did not qualify for coverage of these services under Medicare. The threat of a rejected inpatient stay and the certainty of payment for an extended outpatient visit is a perverse incentive that denies these patients a chance at a ‘qualified inpatient admission’ (3 days) and Medicare coverage for subsequent SNF stays, and also increases their coinsurance costs significantly. Although MAC and RAC auditors had been having a field day denying short inpatient stays3 and demanding millions in recoupments from hospitals, these determinations were frequently overturned by Administrative Law Judges and the Medicare Appeals Council in favor of the hospitals. In response, CMS attempted to clarify the rules, and provided some relief for hospitals by expanding the list of services that they can bill under Part B when a Part A stay is denied. Then CMS proposed a ru...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news