Seniors Face Unexpected Medical Bills Amid Disputes Between Hospitals And Medicare Auditors

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Bloomberg Businessweek: "Elderly patients caught between U.S. hospitals and Medicare auditors pushing to cut costs are increasingly facing tens of thousands of dollars in unexpected medical bills. ... The observation classification [in medical billing] is designed to be used when there isn't an immediate diagnosis, or if it is determined the condition isn't normally treated within an inpatient setting, such as setting broken bones. ... Hospitals, though, sometimes extend the use of observation status to avoid being challenged by Medicare auditors on patient admissions when cases fall in a gray area between inpatient and outpatient.

Inpatients are more costly to Medicare, said Robert Corrato of Executive Health Resources, a consultant for hospitals on how to classify patients. Medicare watches admissions closely, and if an admission is ruled inappropriate, the hospital doesn't get paid. ... Medicare has begun looking into how hospitals use the observation classification" (Armstrong, 7/12).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

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