Cooperating for better care.

News & Views

New Medicare wording on admission status gets pushback

Share this:


On Aug. 6, a  new federal law is scheduled to require hospitals to tell their Medicare patients if they have not been formally admitted and why. But, The (Minneapolis) Star Tribune reports that “some physician, hospital and consumer representatives say a notice drafted by Medicare for hospitals to use may not work.”

The law followed complaints from Medicare patients  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 paper noted.

“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.”

However, Brenda Cude, a National Association of Insurance Commissioners consumer representative and economics professor at the University of Georgia,  told the Star Tribune that the notice assumes “insurance knowledge that we are fairly certain most people don’t have.”

So expect some more language changes.

 Rep. Lloyd Doggett (D.-Texas), who co-sponsored the law, told the paper.“I am concerned that the proposed notice fulfills neither the spirit nor the letter of the law.”

The paper added that  he said that the  law fails to require  hospitals to explain exactly why the patient is getting observation care instead of being admitted and doesn’t clearly explain the difference between Medicare’s benefits.

The paper continued: “The notice, he said, also does not sufficiently explain why observation patients are ineligible for Medicare’s nursing-home coverage.”

For the full article, hit this link.

Contact Info

(617) 230-4965

Wellesley, Mass