New Medicare Notice Requirements

May 5, 2017

In order to receive Medicare coverage for the first 20 days of your stay in a nursing home, you must have been transferred from a hospital after a minimum 3-day inpatient stay. Unfortunately, it can be difficult to know whether you are being kept in a hospital as an inpatient or as an outpatient for observation. Even if you are being kept in the hospital overnight and receiving multiple tests, you may be technically categorized by the hospital as an outpatient. Under Medicare’s rules, you will not be considered an inpatient until a doctor orders such a categorization and the hospital processes that order (Medicare generally advises hospitals to admit you as an inpatient if your expected stay will last at least “two midnights”). This distinction between being categorized as inpatient or outpatient impacts not only your eligibility for long-term care coverage but could also affect your out-of-pocket costs while you’re in the hospital, because (if you have traditional fee-for-service Medicare) your stay will be covered under Part B as opposed to Part A.

 Thankfully, a law has recently gone into effect that requires hospitals to notify individuals who have been categorized as outpatients receiving observation services. Hospitals are required to issue these aptly named Medicare Outpatient Observation Notices, or MOON notices for short, beginning March 8, 2017. Unfortunately, hospitals do not have to provide that notice to patients until 36 hours after the observation services have begun or when the patient is discharged, whichever comes first. Obviously, this time frame is not very helpful for those in a crisis situation trying to figure out if an impending nursing home stay will be covered by Medicare. The best course of action is still to ask the hospital administration whether you are are being kept under observation or as an inpatient. If you are being held under observation, ask for your doctor to order your admission and be sure that the hospital processes that order and maintains that status until you are discharged.

Disclaimer: All materials have been prepared for general information purposes so that can learn more about our firm and services. The information presented above is not legal advice and is not to be acted on as such. While we strive to present accurate information at the time of writing, it may not be current and is subject to change without notice.

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