In our previous Nurses Notes we discussed when there is a need to make a 911 call. Often this leads to someone being taken to a hospital. In this edition you will learn valuable information about hospital processes, Medicare and implications if your loved one is admitted or staying in hospital "under observation". For many caregivers this is often a confusing time and they don't learn fully of these decisions until once their loved one returns home and further treatment is required.
At some point during your stay in the ER, an admissions person will approach you and your loved one with paperwork to sign. They will generally see you before a definitive diagnosis has been decided and a medical plan has been developed.
The first paper form you will receive is titled:
“AN IMPORTANT MESSAGE FROM MEDICARE ABOUT YOUR RIGHTS".
This form explains your inpatient rights and your ability to receive Medicare services while you are in the hospital. It also speaks to your right to a safe discharge plan.
It gives you the name and telephone number of the Quality Improvement Organization (QIO) and the name and number of a person in the hospital if there are further questions or issues.
The second paper form is extremely important for you to pay attention to.
It is a paper titled “OBSERVATION STATUS”.
Make sure hospital staff explain the meaning of this form completely because it can have a huge impact on your loved one depending on what the diagnosis is. Don’t accept the explanation that “it’s just Medicare paperwork” Also, don’t forget that one of your rights is to have an interpreter to explain paperwork so you can understand it. Very often, this is brought to you while your loved one is being evaluated or if a diagnosis and a plan has not been stated to you. You can refuse to sign this paper until you are informed what your loved one’s disposition is.
Here is a brief explanation of the various aspects of Medicare and its role in the treatment plan:
- Medicare, Part A covers inpatient care, skilled nursing care (rehab), home health care, and hospice care. Part A has no co-pay.
- Medicare Part B covers outpatient medical and surgical care, emergency department care, durable medical equipment, and physician charges. Part B has a 20% co-pay.
- If you are in “Observation Status,” Part A does not cover the bills. Part B does. The problem then becomes that the patient is responsible for the 20% co-pay and all the medication costs. This could end up being a huge cost to you and your loved one. The other issue is that if you need rehab, and you are in Observation, you will pay out of pocket for rehab which can cost thousands of dollars.
- Medicare has a rule that a person must be an inpatient (not in observation) for 3 days in order to be discharged to a skilled nursing facility (nursing home). It is only then that Medicare will pay for the nursing home charge. As stated before, if the patient is in observation, the hospital can only discharge them to their regular home.Inpatient or Observation: Knowing the Difference Could Save You Thousands
- Another piece of information: The ER doctor is not the person who makes the decision regarding Observation Status or actual admission into the hospital. The person who makes that decision is the hospitalist. They ae the ones who decide, according to Medicare criteria, if you are on observation or are admitted. When you ask this question, be sure to ask, “am I admitted to observation or as an inpatient?”
- Depending on the diagnosis, if you feel like you won’t be able to take care of your loved one at home, speak with the ER doctor or hospitalist and then ask to speak with a social worker. Let them know the situation at home for your loved one and why you are unable to care for them. If there is a problem, or they are not explaining things to your satisfaction, don’t be afraid to ask to speak to the supervisor in charge.
As in most life situations, paying attention to paperwork that you must sign is always important. Never sign anything unless you are sure you understand it.
Additional readings:
Nurse Bee
