In West Pa., payer-hospital disputes over inpatient status stick patients with bills

Patients admitted to hospitals in western Pennsylvania are increasingly caught up in disputes between payers and hospitals as to whether their stay merits an inpatient or outpatient designation, reports TribLive.

That finding comes from the Healthcare Council of Western Pennsylvania. According to data from the council, insurance companies are disagreeing more often with physicians and hospital staff as to what conditions warrant inpatient admission. As a result, insurers are increasingly classifying multiple days of treatment as outpatient services, or "observation" stays, in order to pay hospitals less, according to the council.

The disagreements are particularly confusing for patients whose financial responsibility may change if their insurance covers inpatient services differently than outpatient services, Daniel Simmons, senior vice president and treasurer of Monongahela (Pa.) Valley Hospital told TribLive.  

Outpatient designations can also cut into a hospital's bottom line.

Based on projections from the first quarter of 2016, the Healthcare Council of Western Pennsylvania estimates 56 regional hospitals that shared data will report about 182,000 observation cases for fiscal year 2016, compared to 146,000 cases reported by 52 hospitals in 2012.

The observation designations could cost the hospitals up to $150 million for the year, according to the council.

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