Medicare coverage for services received in acute care hospitals is probably the most important component of the Medicare program. 95% of all Medicare Part A coverage goes for hospital care.
Beginning no later than March 8, 2017, and as required by the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), hospitals and critical access hospitals (CAHs) are required to give patients both oral and written notice when they are outpatients and not admitted as inpatients.
Effective August 6, 2016, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires acute care hospitals to provide oral and written notification to patients who are classified as outpatients or observation status patients for more than 24 hours.
The issue of rewarding efficiency, regardless of quality, has assumed even greater significance in light of Congress’s expansion of efficiency incentives to post-acute providers in the Improving Medicare Post-Acute Care Transformation Act of 2014.
Requiring standardized language about the “reason” for being placed on Observation Status, which CMS has declared by fiat, thwarts the purpose of delivering information.
The research supports the need for better discharge planning by hospitals and better coordination of care between acute care hospitals and post-acute providers.
The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) released a statement on October 30, 2015 that advises hospitals that it will not administratively sanction them if they discount or waive charges for an outpatient’s self-administered drugs.
Short in-patient stays would be allowed, but only on a case-by-case basis. Short in-patient stays would also be prioritized for medical review, which would consider all treatment during the course of a patient’s hospitalization, not the patient’s presentation at the beginning of the hospital stay.
If the proposed changes lead to an increased number of patients being formally admitted as inpatients (rather than, as now, placed in Observation or other outpatient status), they may help some Medicare beneficiaries. More likely, however, the revision will not significantly change hospital practices and, accordingly, the new rule will not help most Medicare beneficiaries.
We have significant concerns about bundled payments and their potential to result in skimping on care for patients.
2015 Medicare Cost Sharing
Medicare beneficiaries may receive letters from hospitals about their hospitalizations after October 1, 2013 if hospitals decide to withdraw their Part A charges and, instead, bill Medicare Part B and bill the patients for Part B copayments and medications.