My husband was admitted to the hospital for 7 days. He was home for 13 days and had to go back. Doctor that came to the house had a sonogram of his legs done and it found occlusions. She said this should have been done when he was in the first time since he went in for terrible edema and shortness of breath. So 13 days later he went back into the hospital and was admitted again (or so I thought). I got a call from my husband that he was being discharged after 5 days. I went up to the hospital and told them he wasn’t able to come home in the condition he was in and I wanted him to go to a SNF/Rehab. That is when for the first time I was told well he can’t do that he’s been on observation while he’s been here! I had never heard this before and actually didn’t know the consequences to it. I called the hospital when I started to Google things and asked them specifically if my husband was on observation or if he was admitted. I was told he was admitted. I then asked for an itemized bill. When he went into the SNF I was told he was covered fully by Medicare for the first 20 days. I told them about what happened and how I was told on the last day he was there he was on observation for those 5 days, but he was admitted 13 days before that and was in for 7 days that time. I started with the Social Workers who checked and said according to their records he was admitted but they sent me to the Director of admissions. She told me she has called the hospital seven different times and every time she’s been told he was admitted. I haven’t signed any papers but there’s going to be a progress meeting and I’m thinking there’ll be papers to sign there.
My question is two fold. Since my husband was actually admitted to the hospital from 2/4 to 2/11 so he was IN for 7 days. Then home for thirteen days and went back in on 2/24 on observation until 2/28. Entered the SNF on 3/1 and this all happened within less than 30 days wouldn’t the skilled nursing facility be covered because of his first hospital stay? Plus he went in because as per what the doctor said they failed to do a sonogram when he was in and he was getting wound care from home nurses because he’s not ambulatory and can’t go to any appointments. Sonogram had to actually be done at home. So with all that wouldn’t Medicare cover the SNF for that first 20 days? Also since the Director kept insisting there was no problem and that he was admitted would I be liable for the bill or are they? I’m going there tomorrow and I am positive that the hospital is lying and the second visit was indeed put in as observation because I received the itemized bill and can see exactly what Medicare part A hasn’t picked up and it’s an observation code. I’m not done with this hospital by a long shot. This is just touching the surface of their deceit and awful things we’ve been through with them. If anyone can tell me where they think I stand on this I’d appreciate it..
It sounds like you are meeting with the skilled nursing director tomorrow so they should be able to clarify everything, especially since the first hospital visit was an actual admission.
What does the SNF say. They predetermin stays. They know exactly what you will be paying when you sign the financial papers. They check with Medicare and your suppliment. It should be the first 20 days, 100%. 21 to 100 50%. You will be responsible for the other 50% unless your supplimental picks it up. The financial paperwork will tell you exactly what you will owe.
If you are MPOA or his POA you have a right to look at them.
If they do not allow that you may need an attorney to get this done because this is
A) an individual and VERY complicated case
B) We have no access to anything and aren't experts in any of this.
It SOUNDS as though the hospital itself is trying to avoid JCAHO rules for licensure problems.
A little secret here as to the things that hospitals fear most in their checkups by JCAHO hospital accreditation committee.
1. Presence of/numbers of bedsore hospital acquired.
2. Early and unsafe discharge as indicated by early readmission
3. Patients who are confused and fall prone with inadequate (it WAS every 15") checks and records of same.
4. Restraining a patient with devices, bedrails, unsafe clothing
5. Numbers of falls.
6. Hospital acquired infections.
I used to serve on our hospital's teams for JCAHO review and I am well aware of how scary the JCAHO visits are, and the hospital's fear of a ding on their license.
That's what leads me to think that the hospital in your case has something to lose.
I am glad you are addressing this. I think a GOOD ATTORNEY (one knowledgeable about hospitals--read "hard to find") would help but I also think that you need to be in touch with hospital ethic committee and administrative person assigned, and let hospital KNOW you are going to get in contact with the Joint Commission on Accreditation of Hospitals in your area. Their information is online. I wish you good luck.
from an OLD retired RN.