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Senate Looking at Medicare Billing Policies

The Senate Aging Committee Wednesday heard testimony from a panel upset at Medicare policies concerning  how patients are classified for certain services. At issue is what is called observation stays instead of actual hospital admissions. Bob Armstrong, vice president of elder care services at St. Mary’s Health System in Lewiston told the panel that can lead to billing problems when that patient is then sent to a skilled nursing or rehabilitation facility.

"The resident was in the hospital for five days under observation, even though again the paperwork that I had clearly stated that he was an inpatient as well as being admitted," he said. "My facility lost thousands of dollars providing care for this resident with no payment from Medicare even though this patient clearly should have received their Medicare Part A skilled nursing care benefit."

Sen. Susan Collins, the ranking member of the panel, was upset at the Medicare policy and told fellow senators it is unfair to patients.

“To expect a beneficiary to understand whether or not they have been in a hospital bed as in patient versus in observation status is just absurd,” she said.

Collins said the Centers for Medicaid and Medicare need to change their procedures. CMS has raised concerns with hospitals about short inpatient stays, citing that many such stays were improper because the services should have been provided in the outpatient setting.

Journalist Mal Leary spearheads Maine Public's news coverage of politics and government and is based at the State House.