Few people are aware that a nursing home can take such a step. Guardianship cases are difficult to gain access to and poorly tracked by New York State courts; cases are often closed from public view for confidentiality. But the Palermo case is no aberration.
This article (Copyright 2016 – News & Record, Greensboro, N.C.) appeared in the online CPA Practice Advisor online publication, discusses proactive initiatives taken in Greensboro, North Carolina to teach senior citizens the warning signs of fraud at free training sessions, then encourage them to spread the information to their friends and neighbors. Perhaps we might be interested in offering a similar program in the greater NY area?
Submitted by Perry Shulman, CPA 12/30/2016 firstname.lastname@example.org
WHAT IS HOSPITAL “OUTPATIENT” OBSERVATION STATUS?
A hospital billing classification that can make Medicare patients pay for the cost of their:
Nursing Home Care
Patients must be classified as inpatients for 3 days in the hospital in order for Medicare to pay for subsequent nursing home care.
May be called “outpatient,” but it has NOTHING TO DO with where a patient receives care or the kind of care received.
IS A BILLING CODE. Hospitals use it to protect from overzealous auditors and Medicare readmission penalties. May just seem like semantics, but for Medicare beneficiaries,
IT CAN RUIN LIVES. Saddles patients with increased out-of-pocket expenses. Patients who don’t have Medicare Part B are responsible for the FULL COST of the hospitalization.
WHY DOES OBSERVATION STATUS MATTER?
Observation Status can be devastating. It can result in thousands of dollars in hospital bills and thousands more in nursing home bills after a hospital stay.
In 2012 an average hospital stay in the U.S. cost $10,400, and the median monthly cost for a nursing home in the U.S. was almost $8,000.
The use of “outpatient” Observation Status isn’t just wrong, it can be DANGEROUS. Many patients CAN’T AFFORD their care if Medicare won’t pay. If post-hospital care in a nursing home won’t be covered by Medicare, many people GO WITHOUT that care altogether, rather than face the enormous bills. The problem is growing: the number of patients cared for under Observation Status DOUBLED from 2006 to 2014.
Take action at the BEGINNING of a hospital stay to try to stop Observation before it starts.
Ask the hospital doctor to “admit the individual as an INPATIENT” based on needed care, tests and treatments.
Ask the patient’s regular physician to CONTACT THE HOSPITAL DOCTOR to support this request.
FILE AN APPEAL with Medicare, if the patient’s nursing home coverage is denied.
FILE A COMPLAINT with the patient’s state health department, if he/she did not get a notice about “outpatient” Observation Status.
GET AN ELDER ADVOCATE!!!!!!!
The Personal Document Locator is a detailed list of where one stores their important records, the contact information for primary advisors, family members, trustees and other important information. The list should be updated at least once a year to ensure its accuracy.
The list will be most helpful in the event of disability or death.
Please contact me at email@example.com should you have any suggestions or comments.
Perry A. Shulman, CPA