A group of Medicare beneficiaries is suing HHS Secretary Kathleen Sebelius, seeking for Medicare to stop its use of "observation status," which the plaintiffs say deprives Medicare enrollees of the Part A coverage to which they are entitled, according to a Kaiser Health News report.
Several senior citizens — who were placed on observation status for a least part of their hospital stay and did not receive Medicare Part A coverage, for which they were eligible at the time — filed the suit.
The Medicare program considers "observation status" to be an outpatient service and billed under Medicare Part B. Inpatient hospitalization is covered and billed under Medicare Part A.
The lawsuit claims patients on observation status generally receive the same treatment as those patients who have been formally admitted, but the use of "observation status" causes beneficiaries to absorb significantly more hospital costs that otherwise would have been paid for under Medicare Part A.
Observation status also affects Medicare coverage for seniors' skilled nursing facility care. SNF care is conditioned on patients' spending a minimum of three consecutive days as an inpatient in the hospital. Beneficiaries who spend three or more consecutive days in a hospital under "observation status" do not qualify for Medicare coverage of SNF care.
The suit also claims the incidence of placing beneficiaries on observation status, and the average time period in which patient stay on observation status, has been "increasing dramatically in recent years."
If the judge won't eliminate observation care, the seniors' lawyers are asking that hospitals be required to tell patients when they are in observation and allow them to appeal that decision before they leave. Currently, beneficiaries placed on observation status do not receive written notification of their status and have no appeal rights to challenge that status, the suit claims.
In the Kaiser Health News report, a Medicare spokeswoman declined to answer questions about the suit because it is agency policy not to comment on pending litigation.
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Several senior citizens — who were placed on observation status for a least part of their hospital stay and did not receive Medicare Part A coverage, for which they were eligible at the time — filed the suit.
The Medicare program considers "observation status" to be an outpatient service and billed under Medicare Part B. Inpatient hospitalization is covered and billed under Medicare Part A.
The lawsuit claims patients on observation status generally receive the same treatment as those patients who have been formally admitted, but the use of "observation status" causes beneficiaries to absorb significantly more hospital costs that otherwise would have been paid for under Medicare Part A.
Observation status also affects Medicare coverage for seniors' skilled nursing facility care. SNF care is conditioned on patients' spending a minimum of three consecutive days as an inpatient in the hospital. Beneficiaries who spend three or more consecutive days in a hospital under "observation status" do not qualify for Medicare coverage of SNF care.
The suit also claims the incidence of placing beneficiaries on observation status, and the average time period in which patient stay on observation status, has been "increasing dramatically in recent years."
If the judge won't eliminate observation care, the seniors' lawyers are asking that hospitals be required to tell patients when they are in observation and allow them to appeal that decision before they leave. Currently, beneficiaries placed on observation status do not receive written notification of their status and have no appeal rights to challenge that status, the suit claims.
In the Kaiser Health News report, a Medicare spokeswoman declined to answer questions about the suit because it is agency policy not to comment on pending litigation.
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