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  1. #13
    Senior Member
    Join Date
    May 2006
    Somewhere in the Rocky Mountains
    Quote Originally Posted by cass View Post
    apparently, according to hospital staff and my doc, the 23 hr medicare "rule" isn't exactly true. they gave me paperwork stating observation status, i dunno, maybe daisy knows more? anyway, my colon is good.
    As an observation status, they can only admit a patient for 23 hours on paper starting from the time they put you in the system. You can stay up to 48 hours but the hospital only gets paid for that 23 hour observation stay. They have to be converted by doctor orders BEFORE the patient leaves the hospital. That is where most hospitals are missing the boat...getting that timed/signed order.

    The local hospital here is in some deep hot water for 0 day stays.

    Yes it is the rule....23 hours that is and it is being used wrong as lots more fines are coming down this year. You are considered outpatient for those 23 hours. You will be billed as such based on your part B Medicare. It will probably cost more YOU more as an outpatient than if you had just been admitted for one day. Another way M'Care passes the bill on to YOU the beneficiary.

    For an inpatient stay, YOU pay a set amount. For outpatient stays, YOU pay a percentage of Medicare allowable charges.

    It is that same thinking by your doctor that WakeMed is in such deep shiiite. LOL

    The judge was curious how the false billing was confined to Medicare and did not affect privately insured patients.
    Gilmore explained that private insurers insist on approving inpatient procedures in advance. The federal government does not.

    Lots of fraud going on in Medicare. But they just make new rules to combat the fraud that really hurt the patients instead of the hospitals.
    Last edited by darkeyed_daisy; 03-20-2013 at 11:39 AM.
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