Early education is key with Medicare status
Do what you can to stop dissatisfaction
Medicare patients often are shocked to learn that they have a significant out-of-pocket responsibility due to being in observation status instead of inpatient, reports Diane C. Settle, CPA, CHFP, executive director of the revenue cycle at Sarasota (FL) Memorial Health Care System.
“Most questions come into the hospital’s customer service line after they have received their bill,” says Settle.
Patients often are upset that the drugs are more expensive than at a retail pharmacy and that their Medicare supplement does not cover these self-administered drugs under Medicare Part B, says Settle.
Patients don’t understand the additional cost to administer drugs in a hospital, due to pharmacists reviewing all medication orders for patient safety reasons and nursing administering and charting the drugs given to each patient, explains Settle. “For example, the charge for esomeprazole is $26.20 per dose. The patient is upset because they know what they pay a dose for the same drug at a retail pharmacy,” she says.
Members of the hospital’s case management department distribute the “Medicare Inpatient versus Outpatient Letter” to the patients as early in their stay as possible and answer any questions they may have. “We do miss a few patients because of their short length of stay,” she says. (To view the letter, go to http://1.usa.gov/QOo31I).
Patient access is required to notify the patients before their departures from the facility if their statuses change from inpatient to observation as they will be subject to a different and generally higher coinsurance than their initial inpatient status, says Bernadette Lodge-Lemon, director of revenue cycle at University of California — Los Angeles Health System. “It is critical for our clinical documentation to support the level of service being provided to the patient,” adds Lodge-Lemon. “This requires ongoing in-servicing, education, monitoring, tracking, and reporting to all participants in the scope of the patient’s care.” These include physicians, utilization review, registrars, billers, collectors, and medical coders.
Most patients do not understand how they can be classified as an outpatient when they are being treated in an inpatient facility and occupying an inpatient bed, adds Lodge-Lemon.
“It is essential for the registrars to inform and explain to our patients that their observation status is considered to be outpatient and that they will be responsible for the Medicare outpatient coinsurance,” she says.
Medicare patients often are shocked to learn that they have a significant out-of-pocket responsibility due to being in observation status instead of inpatient, reports Diane C. Settle, CPA, CHFP, executive director of the revenue cycle at Sarasota (FL) Memorial Health Care System.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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