Does a family have the right to insist that mom or dad be formally admitted to the hospital rather than held for observation? My understanding is that if a person is not formally admitted to a hospital for 72 hours Medicare will not pay for a rehab stay. Thank you
Unfortunately it’s Medicare as well as insurance company guidelines that are set for a MD to meet criteria for admission.
Doctors have to make a huge clinical decision on a person they don’t know and in my opinion always go in favor of a patient if they truly need care. If the PCP has priveleges at that hospital and makes visits there.
However, that said, often hospitals these days, especially, dedicated to ER medicine & stabilization. The patient’s PCP often gets no say or don’t even know they were admitted until the PCP gets a notification.
Long gone are the days of going to a hospital & expecting an admission. That’s why Urgent Care centers were set up as they are considered an ER & bill accordingly.
So to answer your question, no, not anymore.
Again, Medicare & your government at work, not the hospital staff.
Sad sad sad.
The thing that irritates me most is when the hospital staff keeps pressuring me to sign a document saying that I've been informed that it's observation versus admission. I refuse and tell them that I'm under no obligation to sign that. It helps them, not me. Regardless, they are only required to give oral notification. Nothing has to be signed.
The Centers for Medicare and Medicaid (CMS) has started to look at this issue. The three-night requirement was instituted back in the day when outpatient/home health services were less comprehensive, and when individuals were not as sick and still living in their homes. According to a report I read, CMS is studying this outdated rule, realizing the negative impact it has on Medicare recipients.
Insurance companies make up and follow their own rules as well; generally, when Medicare comes up with a new rule or restriction, the payors adopt it if is financially beneficial to them (and not necessarily the patient) or put their own little spin on it.
As costs rise across the continuum of care, more and more cases are being classified as "observation" now, which is throwing a wrench into hospital budgets and patient and family paid support.
I can also tell you that the rules often are misunderstood, even by the health care systems who are required to follow them, so if you would like an education, go out to the Medicare site and read to your heart's content (or until you can no longer process the conflicting information provided).
It seems a bit daft. If a clinician agrees that a patient needs in-patient therapies and refers him/her for them, why do you have to jump through the hospital hoops too? You can need intensive PT without necessarily having broken your leg.
CM there has to be a strong reason for a patient to need inpatient rehab. Out patient PT can be achieved as an outpatient or by the PT comming to the home
So INSIST that your Mom or Dad be ADMITTED to the hospital and not "Held for Observation".
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