Many older patients, who are on Medicare or in a Medicare Advantage Plan, are shocked when they are hospitalized for less than 3 days only to find out that Medicare will not pay for nursing home coverage following this brief hospitalization. These patients, who are technically admitted for “observation” for less than 3 full days, are in fact, being penalized for getting well faster than a Medicare patient who spends perhaps 4 or 5 days in the hospital.
Medicare is currently conducting pilot projects in hospitals across the country in which Medicare patients admitted to the hospital for less than 3 days, are permitted to continue their recovery in a nursing home, with payment made by Medicare. The hope is that providers that drop the 3-day rule can reduce costs or keep them the same while improving the quality of care. These pilot projects are conducted under a provision of the Affordable Care Act that created the Center for Medicare and Medicaid Innovations to develop ways of improving Medicare. If you have any questions regarding the rules, contact Stark & Stark today.