Nursing home claims DENIED!

In our business,our team lives on the road.

When we aren’t talking about caregiving, we are listening to family caregivers and we hear a lot of personal stories. Many of the stories fall into little buckets or genres that we’ve often heard before.

Recently, we have noticed a new story. This story, unfortunately, will become a recurring theme if we don’t fix the underlying problem. It’s the age-old problem of unintended consequences with no place to point the finger.

Hospitals are using “observation units” when people come into the ER for something and they feel the patient needs to be watched for a period of time.

This care is in the hospital but a less intense level of care and, therefore, less expensive care than “inpatient care”. You might stay several days in “observation status” and since it’s not “inpatient care” those days help save costs for all involved. Sounds like a great solution right?

However, in order to pay for skilled nursing services under Medicare when a person cannot return to their or a family member’s home, Medicare requires a three-day “inpatient” hospital stay.

There’s the catch! Inpatient stay, not observation unit stay. If one of us stays three days in the hospital and then needs to go to a nursing home our natural thought process would think, “Ok, fine, I was in the hospital three days, so Medicare picks up the first couple of weeks in a rehab unit or nursing home.”