HHS' office of the inspector general is urging the CMS to make sure that Medicare beneficiaries have the same access to skilled-nursing services after they leave the hospital, regardless of how their stay is coded on the claim.
The OIG reached that conclusion in a 20-page analysis of hospitals' use of observation stays and short inpatient stays in 2012. Congress and the CMS have raised concerns about how hospitals use observation stays—the short-term services and evaluations in outpatient settings that determine if patients should be admitted as inpatients—and short inpatient stays. The topic is also a hot-button issue for patients-rights groups like the Center for Medicare Advocacy, which argue that patients often end up paying for skilled-nursing care after they leave the hospital because Medicare covers those services only after inpatient hospital stays of at least three days. A group of Medicare beneficiaries has filed a proposed class-action lawsuit in federal court in Connecticut over the costs they incurred because hospitals reclassified their stays as observation after they were admitted. Federal officials have filed a motion to dismiss it, and both sides are waiting for the judge's ruling.
In the spring, the CMS tried to address some of the concerns when it proposed that Medicare contractors presume that inpatient hospital stays lasting two nights or more are reasonable and necessary. The draft policy is intended to relieve some of the pressure on hospitals to avoid having their admissions second guessed by Recovery Audit Contractors.