9 thoughts on “The Two Words That Cost Medicare Patients Thousands

    • Have your mom sign up for a Medicare Advantage (Part C) plan.  Most MA plans waive the 3 midnight rule to qualify for skilled nursing coverage.  This news story is very inaccurate and doesn’t tell the whole story.  Read my comment I left under Jewel McDaniels post.

  1. This is outrageous!! What is the current status of any action to outlaw this  kind of devious misrepresentation??? WHO can I contact and what can I do to address this despicable practice of “kick the sick to the curb to bring in the money; that’s  the bottom line”..

    • This news story is inaccurate.  The reason why hospitals are under pressure to not admit patients into inpatient status over observation outpatient is due to Medicare bounty hunter auditors.  If these auditors can find a reason to take back Medicare payments from up to 3 years prior if it is questionable as to why the doctor admitted patients into inpatient Medicare takes back 100% of the claims payment and the auditor gets a 9% commission.  There were hospitals in the early 2010s that were abusing this because Medicare has a higher compensation rate for inpatient care over outpatient care so Medicare assumes that all doctors are up to something shady to get more money for the hospital from tax payers.  Medicare only compensates doctors around 30% to 50% of their normal rate and forces doctors and hospitals to right off the difference as a loss that cannot be collected (referred to as balance billing).  Hospitals cannot risk having their little payment taken back by Medicare so they Medicare is putting huge pressure on doctors to not admit patients.  If you don’t like the way that the government runs Medicare you can sign up for private Medicare known as Medicare Advantage (Part C) as most MA plans waive the 3 midnight inpatient rule to qualify for skilled nursing coverage.  Medicare Advantage plans are far superior to coverage offered by CMS.  Start watching what doctors are saying about the problems that Medicare gives them and you will understand this issue better.  Your doctor cannot even think about admitting you into inpatient status unless they know for sure that you will require at least 2 midnights in inpatient.  This 3 midnight rule to qualify for skilled nursing coverage has always existed with Medicare but the stimulus bill passed in 2010 and the ACA created many problems for doctors that made working with Medicare even worse.  This is why you should protest government healthcare with every ounce of your body, mind and soul.  Every year since 2001 Medicare has threatened doctors and hospitals with a 20% to 30% reduction in Medicare compensation and Congress understands that if this ever went into effect that doctors would almost universally stop accepting Medicare patients all together so at the final hour every year Congress passes the Doc Fix to make sure that doesn’t happen.  The Baby Boomers are going to bankrupt these programs because there is not enough young workers to fund these programs with how many people are starting to collect benefits.  This is why both Social Security and Medicare are going bankrupt prior to 2030 because the 2017 benefits are collected from 2017 income taxes.

  2. How it works… Central powers force it(healthcare in this case), then businesses either go bankrupt or bypass the law. So it’s back to the original situation… Then they tell you to vote again so we can go through this process again and again and again…

    • That is not how this works.  You don’t understand the relationship of every player involved.  The government pays doctors 30% of what doctors normally charge.  The government’s cheapness with doctors is what causes doctors to overbill Medicare and then Medicare looks at this as tax payer fraud from the hospitals and start cracking down with worse regulations, causing more problems by attempting to solve one problem.  Doctors will eventually stop accepting Medicare patients all together due to how bad the government pays healthcare professionals.  This is why government healthcare coverage is horrible.  Private insurance companies are much more reasonable with coverage than the government is.

    • How much can doctors normally charge?? as much as what the people are willing to pay! Who pays the Govt? The people! Okay?

    • Medicare is funded by current worker salaries so obviously Medicare needs to manage costs, but Medicare only gives an annual payment increase of less than 0.5% when the inflation rate of the US Dollar is minimum of 2% per year.  Medicare payments are now so low that doctors are limiting the amount of Medicare patients that they see and many doctors are starting to refuse Medicare.  Medicare has to pay the hospitals and doctors a fair rate or they will stopped accepting Medicare all together.  Medicare today is paying roughly 30% of what doctors and hospitals normally charge.  That is far too low.

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