I posted a diary in December about my surgery at Cedars-Sinai Medical Center in Los Angeles and tried to write it as a kind of “Hospitals For Dummies” help book. Here it is in the archives. www.dailykos.com/…
The LA Times recently printed an article about a Medicare scam being used by many hospitals. Here it is. www.latimes.com/...What follows is my summary of the full article. It is about a patient who was diagnosed with prostate cancer, entered the hospital for a radical prostatectomy and spent the following two nights on a general surgical ward. Several weeks later he was blindsided with a bill for $25,334 for the hospitalization. The surgeon’s bill was an additional $4,695. There was also the cost for the anesthesia and the surgical suite. Obviously, the man was shocked. This was especially hard for him to grasp because both he and his wife are doctors.
- What happened? When the patient called hospital’sl billing office to complain and remind them that he had Medicare Part A that pays for hospitalization, he was told that he had never been admitted into the hospital thus there was no “hospitalization to cover”. He was in a med-surg hospital room but as outpatient under “observation status”.
- What does that mean? Since he hadn’t been formally admitted to the hospital, those expenses were not covered by Medicare Part A which doesn't cover “observation status”. Medicare Part B does cover outpatient/observation status as well as doctor visits and such. The patient wasn’t enrolled in Medicare Part B but did have Blue Cross supplemental plan that paid some of the costs.
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Why do hospitals do this? There are two advantages. First, it’s a way for the hospital to avoid charges of admitting patients, then discharging them too early then readmitting them soon after. They are penalized by Medicare for doing this. Second, the hospital charges the individual patient without Medicare Part B inflated rates that no insurance company or Medicare would pay. For our good doctor, that came to about $25,000 for three days in the hospital or more than $8,000 per day. As an example, the first two days and the last day of my Cedars-Sinai hospital stay were billed for almost double the other eight days which were billed at a cost of about $350 per day. Observation status for the first two days and discharge days are among the most lucrative revenue streams for a hospital.
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How often does this happen? It is happening more and more as time goes by. About one million Medicare recipients were notified last year that they had been classified as “observational status” and not admitted to the hospital. Medicare reports that some hospitals admit 70% of all their patients on Observation Status.
- What can you do about it? The Center for Medicare Advocacy seems to have the most up to date information and actual things that you can do about it. Here is their web site: https://www.medicareadvocacy.org. If you are being hospitalized for elective surgery get a written statement from your doctor ordering that you be admitted as an inpatient. Nevertheless, many hospitals ignore this or change the doctors orders back anyway. Legally doctors have to agree to the change, but it is often simply changed yet again by the hospital. The letter should remind the hospital of Medicare’s “two-midnight rule”. If the doctor expects the patient to require hospital care for at least two midnights, then the hospital should be able to determine that this patient meets the standard to be admitted as an inpatient. The law now requires that patients be notified of their observation status within the first 36 hours. There is a Medicare form developed to do this. It has the happy name of the Medicare MOON form. This is the form that I was bullied to sign. Here it is for you to read. www.cms.gov/…
- What does all this mean? The practice of medicine in America is a business with a business model to maximize profit, monetize everything right down to dealing with patients as “revenue streams”. The Republican controlled Senate has been sitting on bills passed in the House for years. WHAT THIS ACTUALLY MEANS IS THAT WE WILL HAVE TO SAVE OURSELVES. PERIOD. FULL STOP.
- Or not….….