EagleTribune.com, North Andover, MA

Merrimack Valley

July 22, 2013

Inpatient or outpatient? Status could determine Medicare eligibility


Medicare Part B covers outpatient hospital services and the individual would be responsible for a co-payment for each outpatient service provided. The total copayment for all services combined may be more than the inpatient hospital deductible. Drugs administered in this setting in most instances would not be covered by Part B. If the patient has a Part D plan (Medicare prescription drug coverage) the medications may be covered.

The issue many individuals have been most concerned over is in regards to the payment for skilled care provided in a rehabilitation facility following discharge from the hospital. Medicare only covers the cost of this care when there is a 3 day “qualifying hospital stay”. Observation or outpatient status does not meet the guidelines for the 3 day requirement since officially the person was never admitted to the hospital.

Never assume just because an individual spends the night or even several nights in a hospital the person has been officially admitted. Ask immediately what the hospital status is...inpatient or outpatient? This not only impacts cost of services provided but also whether Medicare will cover the care received in a skilled nursing facility (SNF).

Patients and family members need to understand the importance of advocacy and should speak with the hospital’s utilization or discharge planning department if they believe an improper decision has been made.

For additional information or to schedule an appointment call 1-800-892-0890. Do you have a question? We encourage inquiries and comments from our readers. Direct correspondence to ro@esmv.org or Elder Services of the Merrimack Valley, Inc. 360 Merrimack Street B#5, Lawrence, MA 01843. Rosanne DiStefano is the Executive Director of Elder Services of the Merrimack Valley, Inc.

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