Medicare Pilot Aims to Reduce Costs for Seniors
Hospital payment rules will be relaxed at select hospitals during a 3-year pilot in an effort to avoid leaving seniors with unexpected bills.
In response to concerns that a growing number of seniors are facing unexpected hospital and nursing home bills, The Washington Post reports that Medicare is launching a 3-year pilot program that will relax hospital payment rules. Under the current system, hospitals must classify patients as inpatients or observation patients and hospitals can be heavily penalized for billing an observation patient as an inpatient. As a result hospitals are cautious about billing patients as inpatients, causing Medicare to pay less and leaving the bill to the person who is treated. Compounding the problem is the fact that hospitals are not required to inform patients of their designation. Observation patients can also be charged higher co-payments, billed any amount for routine maintenance drugs like asprin, and are not eligible for Medicare covered follow-up care in a nursing home. The pilot will relax the billing rules for the 380 participating hospitals by allowing them to rebill services rendered if their initial claim for inpatient services is rejected. With the rule change they can still receive 90 percent of the allowable Medicare payment in exchange for giving up their right to any appeals.
