There are two definitions for the 72 Hour Rule & Medicare

The 72 Hour Rule And Medicare

There are actually two main answers to the 72 hour rule and medicare. The answer you are looking for will depend on which side of the fence you stand on.

The most common question is about patient rights regarding reimbursement for your hospital stay. There's also patient billing, if you are the administrator in a care facility.

Patient Rights:

If you want Medicare to pay for your Long Term Care costs, you must stay in the hospital for at least 72 hours. Many hospital stays are three days and two nights, which is not a full 72 hours. So if your hospital stay is approaching the 3 day mark, talk to your station nurse about waiting until 72 hours has past before they discharge you.

You must have Medicare Part A coverage to qualify for the 72 hour benefit. If you have any questions about which Medicare insurance plan would best suit your needs, fill out the form at the bottom of this page and one of our representatives will contact you.

Download this PDF document for a more detailed description of the 72 hour rule and Medicare for personal claims. 72 Hour Rule pdf document

Medicare Appeals and Grievances

When you are enrolled in the original Medicare plan you have the right to appeal if you feel you have been treated unfairly. For a definition of those rights look on the back of the "Explanation of Medicare Benefits or Medicare Summary Notice" It will be on your Medicare bill for the service provided.

You have appeal rights for Managed Care plans and Prescription Drug plans. You are also protected when you are in the hospital whether you are with the Original Medicare plan or the Medicare Managed Care plan.

• You have the right to get all the hospital care you need, and any follow up care required.

• You also have options if you think the hospital is making you leave too soon.

For any questions regarding these matters you can call 1-860-MEDICARE. If you ask a Quality Improvement Organization (QIO) to review your case, you may be able to remain in the hospital free of charge. You cannot be forced to leave the hospital before the review is completed by a QIO.

Healthcare Compliance Plan For Hospitals

There is a three day window where Hospitals can collect on unrelated work done for a patient as long as the 72 hour window applies. Diagnostic services performed within three days prior to hospital admission can be bundled into the DRG payment.