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Tuesday, July 5, 2016

Medicare Observation Care Requirements

Controversy Erupts Over Medicare Observation Care Requirements
In August, a federal law kicks in requiring hospitals to tell their Medicare patients if they have not been formally admitted and why. But some physician, hospital, and consumer representatives say a notice drafted by Medicare for hospitals to use may not do the job. The law was a response to complaints from Medicare patients who were surprised to learn that although they had spent a few days in the hospital, they were there for observation and were not admitted. Observation patients are considered too sick to go home yet not sick enough to be admitted. They may pay higher charges than admitted patients and do not qualify for Medicare's nursing home coverage. The NOTICE Act requires that, starting Aug. 6, Medicare patients receive a form written in "plain language" after 24 hours of observation care but no later than 36 hours. Under the law, it must explain the reason they have not been admitted and how that decision will affect Medicare’s payment for services and patients’ share of the costs. The information must also be provided verbally and a doctor or hospital staff must be available to answer questions. Brenda Cude, a National Association of Insurance Commissioners consumer representative and professor of consumer economics at the University of Georgia, said that the notice is written for a 12th-grade reading level, even though most consumer materials aim for no more than an 8th-grade level. It “assumes some health insurance knowledge that we are fairly certain most people don't have." Medicare is soliciting feedback on the draft notice through June 17.

Source/more:USA Today


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