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Life Health > Long-Term Care Planning

Lawmaker: “Outpatient Observation” Label Derails Care Transitions

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Terminology can get in the way of skilled nursing facility (SNF) claims when hospitals misclassify inpatient care as outpatient care, according to Rep. Joe Courtney.

Courtney, D-Conn., organized a briefing on the issue last week in Washington in an effort to round up support for H.R. 1543, the Improving Access to Medicare Coverage Act of 2011.

Medicare pays for patient care in an SNF only if the patient first had a stay in an acute care hospital.

In some cases, Courtney said at the briefing, a hospital puts a patient in a bed for several days, provides medical care and nursing care, and even supplies the patient with food and a wrist band, but calls the care “outpatient observation” rather than inpatient care.

When a patient in that situation moves to an SNF, Medicare refuses to pay for SNF care, Courtney said.

Courtney organized the briefing on the issue with help from the Center for Medicare Advocacy, Willimantic, Conn., and medical provider groups.


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