By Regina Salmi, Area Agency on Aging of Western Michigan
You don’t feel well. You might go to the emergency room, where after initial triage, you’re taken to a hospital room. You’re in a gown, you’ve got an ID bracelet, nurses and doctors are visiting you, and you are given medication. You are inpatient, right?
Maybe not. Under Medicare rules for hospitalization, you can be admitted to a hospital under observation or as an inpatient. While the treatment you’re receiving might be almost identical, no matter your designation, under Medicare rules, it could be the difference between a co-pay or thousands of dollars in medical bills. It is important to understand the difference and know your rights when you are in the hospital.
An example, when Steve suffered a fall, resulting in broken ribs and a severe sprain, he spent 4 days in the hospital. Before returning home, he was transferred to a rehabilitation facility for two weeks in order to recover. After Steve returned home, he received an extremely large medical bill in the mail, because Medicare did not pay for his stay at the rehabilitation facility. He was dumbfounded. What he discovered through multiple inquiries was his status at the hospital was observation, not inpatient, prior to going to rehabilitation. Therefore, he was billed for his entire stay at the facility.
Bob Callery, MMAP Regional Coordinator explains, “When a person’s status is inpatient during their hospital stay, it is billed through Medicare part A. As long as they were inpatient during their hospital stay for 3 days, if transferred to a rehab to continue recovery, Medicare part A will pay for that stay as well. Observation, on the other hand, is billed through Medicare part B. If a person’s status is ‘observation’ and they are transferred to a facility, Medicare part B will not cover that stay and patients are billed for their time in rehabilitation.”
What can we do to avoid getting whacked with a huge medical bill?
Callery says, “Get the MOON!” That stands for the Medicare Outpatient Observation Notice (MOON). As of March 8, 2017, hospitals are required to give patients this form within 24-36 hours of an observation stay. The MOON will let you know whether your status is observation or inpatient and the coinsurance amount you might have to pay. It will also inform you that if you need to go to a skilled nursing facility after your stay in the hospital, your care will not be covered by Medicare if your admission status is observation rather than inpatient.
If you are in the hospital, you or your family member need to make sure you receive this form. Your physician’s decision to transfer you to a skilled nursing facility may be the best treatment decision for you, but s/he may have forgotten that you were originally admitted on an observation status rather than inpatient. In order for Medicare A to cover the costs of rehabilitation, you must be in the hospital under inpatient status for at least 3 days prior to being transferred. If your doctor wants you to continue to recover at a facility, your status needs to be changed before the transfer takes place.
Medicare, with all of its rules and various parts, can be very confusing and difficult to untangle. Remembering to ‘Get the MOON!’ will help you avoid unnecessary medical bills when you’re in the hospital. In addition, there is MMAP. This is Michigan’s Medicare/Medicaid Assistance Program. MMAP’s purpose is to help “educate, counsel and empower” people about their Medicare/Medicaid programs and benefits. MMAP, Inc. works through the Area Agencies on Aging. MMAP can also help you appeal a Medicare bill you believe is incorrect, but more importantly, they can help you understand your coverage to avoid receiving those bills in the first place.
If you have questions about your Medicare plan, you can contact MMAP at aaawm.org 800.803.7174 or email aaainfo@aaawm.org. You can also visit www.mmapinc.org to learn more.
