Reintroduced observation status bill could take edge off Medicare 3-day rule

[Northeast Agent]

[EXTERNAL LINK] - Reintroduced observation status bill could take edge off Medicare 3-day rule

The bipartisan Improving Access to Medicare Coverage Act of 2023, introduced on Aug. 4, is aimed at fixing what its sponsors called an “arbitrary Medicare policy that excludes coverage of skilled nursing care for certain patients, resulting in exorbitant and unexpected out-of-pocket costs.”

Medicare rules require three admitted nights for coverage of a skilled nursing facility stay, but hospitals label some patients as under observation, an outpatient status whose coding effectively negates time accrued toward the three nights, and interferes with coverage for post-acute stays.

 

[somarco]

Sounds positive. So where's the catch?

 

[Midlevel]

I’ve never really understood the 3 night Hospital rule. What if a 65 year old tears their quad muscle and has surgery the next day and is in good shape so is released from hospital after 2 nights, why do they not have a right to skilled nursing for rehab to get them back on their feet?

 

[goillini52]

I’ve never really understood the 3 night Hospital rule. What if a 65 year old tears their quad muscle and has surgery the next day and is in good shape so is released from hospital after 2 nights, why do they not have a right to skilled nursing for rehab to get them back on their feet?

Cuts down on their payments to SNF's.

 

[Midlevel]

Cuts down on their payments to SNF's.

All the talk about having trouble getting SNF approved on MAPD. At least they don’t have to be in the hospital 3 nights to have a chance of at least getting SNF paid for. Had quite a few people get screwed with under observation on my Med Sup and Cost Plan clients.