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Wednesday, July 31, 2013

HHS Inspector General Scrutinizes Medicare Observation Care Policy

Medical treatment costs paid in workers' compensation claims continue to exceed 50% of the losses paid. The Federal government is attempting rein in medical costs generally. Those efforts will impact workers' compensation medical payments. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Medicare patients' chances of being admitted to the hospital or kept for observation depend on what hospital they go to -- even when their symptoms are the same, notes a federal watchdog agency in a report to be released today, which also urges Medicare officials to count those observation visits toward the three-inpatient-day minimum required for nursing home coverage.

The investigation, conducted by the Department of Health and Human Services Inspector General, was based on 2012 Medicare hospital charges. Its findings, which underscore several years of complaints that the distinction between an inpatient and observation stay isn't always clear, come just days before the Centers for Medicare and Medicaid Services (CMS) is expected to issue final regulations intended to address the problem.

Those rules, proposed in April, would assume that patients who stay two nights or longer in the hospital are inpatients. Those who have shorter stays would receive observation care, an outpatient service. However, the IG report said the proposal, which has been criticized by hospital, physician and consumer groups, would not reduce the number of observation stays.

An observation patient can be treated in the emergency room or on an inpatient unit in the hospital. CMS does not require hospitals to tell patients they are receiving observation services, which the IG's analysis said can include some of the same procedures provided to admitted patients.

"Some...

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