New Medicare Rules Cause Confusion - KOTA Territory News

New Medicare Rules Cause Confusion


New Medicare rule changes that went into affect in October are causing concern and confusion. It is a government regulation change that could end up costing you quite a bit of money.

When you go to the hospital with an illness or injury, you might be assigned a room. You would think that is enough to be considered an inpatient, but you would be wrong. It's all part of new rule changes by medicare.

Anita Dunham, RN, is the director of care management at Rapid City Regional Hospital. She says new Medicare rules now categorize inpatient care at two levels.

"One is inpatient. The other is out–patient observation. It's very confusing," Dunham said. "The provider is expected to analyze how serious the condition of the patient, what the treatment plan is and then the care managers that I work with, screen all admissions to make sure we're meeting the medicare rules and regulations and then educate patients and families so they're not surprised."

How Medicare has modified inpatient criteria is what is new and confusing.  Dr. Robert Houser, vice president of medical affairs at Regional Hospital, says:  "A good way to explain it is a patient comes in with chest pain, someone that's say 45 with a singular complaint. We want to make sure there's no heart disease. If they rule out cardiac problems, the patient goes home the next day."

Under this scenario, this patient would be considered an outpatient, and usually stay one or two nights in the hospital. The reimbursements for Medicare and most insurance companies vary widely depending on how your stay is categorized. The Medicare rules are thousands of pages.

So you need to pay close attention to whether you are admitted. And ask hospital staff if you have questions before you are discharged.

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