MN053 Are You Being Admitted to the Hospital or Are You Under Observation

The NOTICE ACT On August 6, 2016, The Notice of Observation Treatment and Implication for Care Eligibility Act, went into effect. (Sec. 2) This bill amends title XVIII (Medicare) of the Social Security Act to require a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services(Medicre) to give each individual who receives observation services as an outpatient for more than 24 hours an adequate oral and written notification within 36 hours after beginning to receive (Observation Services) which: explains the individual's status as an outpatient and not as an inpatient and the reasons why; explains the implications of that status on services furnished (including those furnished as an inpatient), in particular the implications for cost-sharing requirements and subsequent coverage eligibility for services furnished by a skilled nursing facility; includes appropriate additional information; is written and formatted using plain language and made available in appropriate languages; and is signed by the individual or a person acting on the individual's behalf (representative) to acknowledge receipt of the notification, or if the individual or representative refuses to sign, the written notification is signed by the hospital staff who presented it.    Here is the link to the Federal Register, which explains in more detail Procedures Applicable to Beneficiaries Receiving Observation Services: https://www.gpo.gov/fdsys/pkg/FR-2016-04-27/pdf/2016-09120.pdf   Medicare Advantage Plans  “A beneficiary enrolled in a Medicare Advantage or other Medicare health plan would receive the required notice under the existing rules that apply to hospitals and CAHs under a provider agreement governed by the provisions of section 1866(a)(1)(Y) of the Act.”   If you are enrolled in a Medicare Advantage Plan, you are covered under the provisions of your plan. READ your plan’s Evidence of Coverage (EOC) to determine what your out-of-pocket expenses will be in this situation.   I am urging each of you to be Pro Active with your own Health Care! If you or a loved one goes to the Emergency Room or a Critical Access Hospital, be prepared to speak up! Speak to the Physician in the ER who is treating you. Ask the physician specifically…..”Am I being ADMITTED to the hospital as an INPATIENT?” If the answer is “Yes,” you will be covered under Medicare Part A benefits.  If the answer is…. “No…..you are UNDER OBSERVATION. OR……”No……you are receiving OUTPATIENT SERVICES.”  You WILL more than likely be responsible for co-payments, co-insurance or maybe ALL charges! Call your Primary Physician or Specialist. Tell the office or Answering Service that you or your Family member is in so and so Emergency Room, so and so hospital and you want your Doctor to either: Come to the hospital and examine you to determine if you should be admitted to the hospital as an inpatient                                            OR Have your doctor speak to the Emergency Room physician who is treating you, in order to determine if you will be admitted or able to be discharged from the Emergency Room.   You Should NOT have to be in an Emergency Room for up to 23 and a quarter hours UNDER OBSERVATION! Your Primary Doctor is the “Quarterback of your health team!” Your Primary Doctor is in charge of your health care! That is what they get paid to do all that extra paperwork for! Put them to work for you!   Do you have a Medicare Question? Send it to Support@TheMedicareNation.com Tell a friend or family member to SUBSCRIBE to Medicare Nation. They’ll get a new episode on their laptop, tablet, or phone every Friday so they won’t miss an episode Don’t know how to subscribe? Visit my short video to show you how to do it – step by step. Find all our shows on the Medicare Nation website – www.TheMedicareNation.com Finally, Medicare nation will be having its ONE YEAR Anniversary in a few weeks. I”d love for you to help me celebrate this past year of guests, topics and questions from listeners….by telling me what you’ve enjoyed most about Medicare Nation. Go to my website www.callsamm.com And “Click” on the contact tab. You’ll see a button that says “ Record Your Message Here.” Click on it and start talking! No equipment required! You’ll be able to leave a short message of what you’ve enjoyed over the past year on Medicare Nation. If you’d like me to announce your celebration message, leave me your first name & city & tell me “I want to be ON Medicare Nation.”     Thank you for being part of Medicare Nation’s Anniversary!