A whistleblower can continue to pursue charges that a Nevada healthcare network routinely admitted people as hospital inpatients when they should have been placed in observation status, a federal appeals court recently ruled.
Hospitals have been cast in a harsh light by long-term care advocates recently for allegedly over-using "observation stay" status. The practice can ultimately deny some patients subsequent Medicare coverage for nursing home admission.
The nation's largest hospital organization has agreed to a $98 million settlement to resolve charges that it overbilled by admitting individuals as inpatients rather than keeping them under observation, the Department of Justice announced Monday.
I'm confident I'm not the only person who has worked in a hospital or long-term care who has heard this conversation about someone elderly who has recently died. "Well, she fell and broke her hip a few months ago," Person A says. Person B shakes her head and says, "Well, after that, it's all downhill."
The American Hospital Association and other hospital groups have sued the federal government over the so-called "two-midnight rule," which was designed in part to ease access to skilled nursing services. The rule undermines the judgments of physicians and other clinicians, the hospital associations stated in their complaint, filed Monday in U.S. District Court.
It's been said for a long time that a picture is worth a thousand words. Moving pictures? Start multiplying the worth. Add some sound or speaking to those moving pictures, well now we're talking really, really big impact. Long-term care providers are hoping so.
Q: You co-authored a study on how specialized hospital observation stay units could increase transparency and allow quicker inpatient admission decisions. This would help people meet the three-midnight requirement for skilled care. What are the characteristics of type 1 unit care?
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.
There are many odd animals roaming our healthcare industrial complex. But few are more bizarre than Medicare's three-day rule. Or more deserving of extinction.
The former head of the Centers for Medicare & Medicaid Services has said the agency should scrap a rule requiring three days as a hospital inpatient to qualify for Medicare coverage of skilled nursing care. Long-term care advocates praised the statement.
Long-term care groups are among those hailing a federal study that raises critical questions about hospitals' apparent over-use of "observation stay" designations for patients.
When you complain about bizarre government conditions or regulations, as columnists are wont to do, you usually have to assume you're just whispering into a stiff wind. But now comes word that no less than the Office of Inspector General of your Department of Health and Human Services is jumping on the bandwagon to change the hospital "observation stay" madness.
What is this world coming to? When you complain about bizarre government conditions or regulations, you usually have to assume you're just whispering into the wind.
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.
While CMS tries to figure out how to proceed with the manual medical review process, we continue to track our caps and apply our modifiers. In the meantime, has anyone noticed how our typical Medicare Part B patients have become more medically complex than just a few years ago?
Government lawyers and opponents of Medicare's "observation stay loophole" squared off in court on Friday, when a federal judge convened the first hearing in the Bagnall vs. Sebelius case.
Bully for provider groups pulling out the stops to draw attention to the ludicrous mishandling of "observation stay" designations by many hospitals. One prong of the plan is to have providers supply anecdotes about individuals hurt financially and emotionally by the practice.
It was welcome news Tuesday to learn that the confirmation hearing for the person who could officially wind up holding the purse strings for most nursing home payments was civil. Even better was the nominee saying she would look into the ridiculous state of affairs concerning 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.
Provider groups assert regulators should update existing policies when determining hospital inpatient and outpatient admission status.
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.
Proponents of a bill to cut out the "observation stay" Medicare loophole got a boost from a House of Representatives member Wednesday.
Physicians and hospitals increasingly are admitting more Medicare beneficiaries for observation stays rather than as hospital inpatients, new research concludes.