Tag Archives: ER

And You Thought “Mooning” Went Out With Hot Rods…………

In the beginning of 2017, Medicare implemented the new Medicare Outpatient Observation Notice which seems to have the same effect as the old ‘mooning’ we think about from American Grafitti.

You see, MOONing in Medicare (sounds like a love song from Cole Porter, doesn’t it?) means that within 36 hours of entering a hospital, if you will not be admitted, but only kept under  “observation,” they must inform you with a written explanation.  This is the form, if you’d like to see it!

MOON FORM

The problem with this form is the unintended consequences it might have for you, if you are on Medicare, or your loved one, if you are a caregiver for someone who is on Medicare.

If a patient is placed under observation, typically in the Emergency Room, and is never formally “admitted” to the hospital, Part A hospitalization of Medicare does not pay. In other words, you are paying as an outpatient.  For a quick trip to the ER (is there such a thing?) that’s no big deal. After all, the Part A deductible is $1340.00 so you may not even spend that much if you’re only there a few hours.

However, if you are there a few days, and you stay on observation, it is likely that you will start racking up fairly high medical costs with co-pays for every service you are getting. Not to mention any drugs, that likely will not be covered by your Part D while you are in the hospital. It’s complicated, scary and could be costly.

The worst result could be that you are sent to rehabilitation, and because you never met the “admitted to the hospital for 3 days” requirement to have Medicare pay for at least 20 days in that rehabilitation center, you are now responsible for a significant bill coming out of that rehabilitation center. This has happened to people to the tune of thousands of dollars.

So what can you do?

This advice comes directly from this AARP article, which oddly was written before MOON became a regulation and before the MOON form existed. So I have added two of my own suggestions at the end:

Medicare: Inpatient or Outpatient?

  • Ask about your status each day you are in the hospital, as it can be changed (from inpatient to observation, or vice versa) at any time.
  • Ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
  • Ask your own doctor whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
  • If, after discharge, you need rehab or other kinds of continuing care but learn that Medicare won’t cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare’s home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
  • If you go to a skilled nursing facility and have to pay for it yourself, you can try formally appealing Medicare’s decision. When you receive your quarterly Medicare Summary Notice, make a copy and highlight the facility’s charge. Send this to the address provided on the notice with a letter saying you want to appeal Medicare’s decision of noncoverage on the basis that you should have been classified as an inpatient during your hospital stay and not placed under observation. If this is denied, you can go to a higher level of appeal, following instructions on the denial letter.

Additionally,

  •         You can refuse to sign the form. All that does is make the hospital sign it, and make them a bit testy. But it signifies that you do not accept this and hopefully is evidence on Appeal that you were trying to fight the observation status.
  • You can take your patient home. I am not recommending this, especially if the whole reason you are fighting ‘observation status’ is because your patient is very sick and you are certain they will end up in the hospital, a rehab center, or a skilled nursing facility after this event. But one of the problems with Medicare is that they penalize hospitals for re-admissions. So discussing the possibility that you might take your loved one home, that might force a re-admission, may move them to admit your loved one.

Sometimes this feels like the “Art of War,” when dealing with healthcare issues. Being forewarned is being forearmed, as they say. Seems like anything is better than being MOONED!

“You Just have to Laugh…..”

©2018 Cathy Sikorski

Winner, winner, Jack Daniels for dinner? If only…………..

The beauty of sharing a sense of humor with the one you are caregiving for is beyond measure.

My brother-in-law has been in and out of rehab and the hospital for 8 months now. It has been a rocky road……and not sweet, like the ice cream. But he has turned a miraculous corner and although, still in rehab for a few more weeks, I have confidence that he will finally be returning home and will be relatively healthy for a good long time.

Since he has come so far, he is finally taking an interest in his daily life and activities that eluded him while desperately trying to get healthy. And he’s funny again. He is entertaining his healthcare workers, and any one else who walks in the door, which, of course, I love.

On my trek to see him yesterday, I took my Mom and husband as we were then going to have dinner with a friend who lives close by the rehab center. It takes us an hour to get there, so we decided to take advantage of being in our friend’s neck of the woods.

A half hour before we left, there appeared some calls and one message on my cell phone from the rehab center. The nurse stated that my BIL had a few lab work issues, but if I didn’t get back to her today, we could discuss it tomorrow. As I was on my way down there to see him, I thought: Okay, no big deal. I did return her call, but she was gone for the day.

When we arrived at his room, his bed was stripped and  his wheelchair was empty. That is always a panic button for any caregiver. Where the hell is my brother-in-law????? At the nurses’ station, the nurse tells me that they sent him to the ER because his hemaglobin was so low, he might need a transfusion.

“You couldn’t leave a message that he’s at the hospital, that I just passed on the way here, so I could stop there first?”

No answer.

Off we go to the ER and they usher us into his room. There he is joking with the nurses, and, feeling relieved that he seems okay, I say, “well, yet another hospital we get to check out. Whoopee!”

This is how I know he’s ever so much better overall: “Well at least, it’s  not a Friday night!” he says.

Classically, for the last 8 months, we have gone to the hospital without fail on a Friday night. I told him my husband was getting jealous of our date nights.

jack-daniels-551052_1280Then he turns to the nurse and asks, “can I have a Jack Daniels with that Percoset?”

Then he goes into a litany:

“So now I’m going to miss my dinner. I told them at rehab, “hey, what about dinner?”. Then I come here and I’m asking them, “where’s my dinner?” But no, no dinner. And you know they’re going to screw around, and no food or drink until they decide what to do with me. And then they are going to  tell me I’m fine, because I feel fine, but then what about my dinner?”

onion-rings-274123_1280See, all of this is a sure sign that all is well in brother-in-law land. If his focus is dinner, dinner, dinner…………….he’s in great shape. You caregivers know what i mean.

In the spirit of kind caregiving and true sympathy to his plight, I say:

“Well, okay, now that we see you’re okay, we’re going to take our friend out to dinner! See you  later!”

He bursts out laughing. Yay…………

“You Just have to Laugh………..”

© Cathy Sikorski