Observation Stay Loophole
Dedicated observation stay units could protect nursing home benefits, save hospitals $1 billion annually, researchers sayDecember 06, 2013
Specialized hospital units for patients under observation status could dramatically reduce the number of seniors forced to pay out-of-pocket for skilled nursing care, according to findings in the current issue of Health Affairs.
Government lawyers and opponents of Medicare's "observation stay loophole" recently squared off in federal court, when a judge convened the first hearing in the Bagnall vs. Sebelius case. Richard Bagnall and other seniors denied Medicare coverage for skilled nursing care brought the case in 2011.
We've had problems with residents being caught in the hospital "observation stay loophole." What can we do to ensure they qualify for coverage at our facility?
Lawmakers in the House and Senate formally introduced legislation to close the so-called "observation stay loophole" on Thursday.
A new U.S. Senate bill would change a Medicare provision preventing many seniors from getting coverage for skilled nursing therapy after hospital "observation stays."
Hospitals have been undergoing more and more restrictions on re-admissions and are now facing financial penalties in some situations. Unfortunately, this has also resulted in more patients not being classified as "admits" or "re-admits," but rather getting coded as "observation" stays.
A long-term care group is urging regulators to continue work on fixing the "observation stay loophole" that makes it harder for Medicare beneficiaries to get nursing home care.
Faced with growing complaints about the "observation stay loophole," the Centers for Medicare & Medicaid Services is launching a pilot program that could ultimately help beneficiaries afford nursing home care.
Physicians and hospitals increasingly are admitting more Medicare beneficiaries for observation stays rather than as hospital inpatients, new research concludes.