South Nassau's case managers attempt to explain the distinction to observation status patients so they are aware of their out-of-pocket obligations. However, trying to have those conversations with patients who are receiving care in the hospital is challenging, Carnevale says.
"They are sick, they are in bed, and we're trying to explain billing and collections. They don't understand, and they are angry, and I don't blame them," she says. "We try to explain that this is the regulation, and we are trying to follow it to the best of our ability."
Carnevale also fears that HCAHPS scores from patients who are upset about medical bills could further reduce her organization's revenue.
"Our reimbursements are also based on satisfaction scores," she says. "We're trying to satisfy patients and take care of them clinically, and we're trying to advise them on something that is very, very confusing. It's a balancing act, and hopefully some patients or many patients do have good healthcare coverage and supplemental insurance that covers Part B deductibles."