New law requires patients be warned of upcoming expenses from loophole in Medicare law.

Congress has moved to help alleviate problems caused by a quirk in the Medicare admittance law, according to a report in The New York TimesNew Medicare Law to Notify Patients of Loophole in Nursing Home Coverage.”

If a patient is formally admitted to a hospital and Medicare rules it was not done properly, there is no reimbursement for the bill. Because of this, many doctors may keep the patients in the hospital under observation and there is no distinction to the patients at the time. They will receive the same treatments. However, it makes a big difference if a Medicare patient is later admitted to a nursing home for treatment and rehabilitation.

Under such circumstances, Medicare will not cover the nursing home stay unless the patient was formally admitted into a hospital for at least three days. This leaves many patients without insurance coverage for their nursing home care and they are required to pay for their stays.

Under the new law Medicare patients who have been in a hospital under observation for 24 hours must be given notification about their status and what that can mean for subsequent Medicare reimbursement. This should give patients the opportunity to speak with their doctors and request that they be formally admitted to the hospital.

Some members of Congress are also seeking to fix the problem completely and allow time spent in a hospital under observation to count the same as time spent formally admitted to a hospital as the same for reimbursement purposes.

Philip J. Kavesh
Nationally recognized attorney helping clients with customized estate planning guidance for over 40 years.
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