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Sylvia Gordon

2018 CSA Conference

 

Sylvia Gordon, JD

Gordon Marketing
President
sgordon@gordonmarketing.com
www.gordonmarketing.com

 

 

The MOON Rule and How Your Clients are Being Manipulated By Under Observation Status

While Congress made a small, first attempt to fix the "Under Observation" limbo in 2016 that hospitals employ to their benefit and the detriment of the Medicare beneficiary, much still needs to be done to fix this loophole. Agents still don't understand what is happening, the basis for the hospitals' position and what rights their clients have when facing a potential in patient stay.

More than 1 million Medicare beneficiaries annually are coded as Under Observation and this has some dire consequences for your clients that you are unable to change. Knowledge is power, but the real power comes in mobilizing your clients to demand their congressional representatives put an end to the abuse of this status.

Most agents are confused with the sudden use of this coding and are at a complete loss when asked to explain it to their clients. Clients incorrectly assume they have more control than they really do, as they are unable to demand to be admitted as an inpatient.

Hospitals, insurance companies and nursing homes are all graded and their reimbursements are tied to their federal grade. One of the most important criteria that CMS looks at is hospital readmission rates. As insurance carriers get more creative in trying to prevent re admits (Anthem's new 10 day mean plan on their 2018 DSNP is an innovative approach that should catch on across the industry) hospitals went the opposite direction. Instead of putting discharge plans into place to lower readmits, they just lowered their risk by not "admitting" high risk patients.

Under Observation status is a cheat. Like many of our great institutions, sly cheats like this will positively skew the numbers in their favor until everyone catches on and stops it. For now, we--agents and our clients-- are powerless to change the behavior of the hospitals, but together we can have our voice heard in Washington and put an end to this abuse.

Learning Objectives

  1. Better understanding of the under observation status.
  2. Learn why hospitals use it and what is in it for them.
  3. Understand how it hurts the Medicare beneficiary.

About Sylvia

Sylvia Gordon is the President and co-owner of Gordon Marketing, one of the largest FMO/NMO/IMO offices in the nation. Founded over 30 years ago by her father, Dick Gordon, as a regional Health Insurance Agency, Sylvia and her sisters Rebecca and Theresa took the company national in 2006. As the only female owned and operated FMO in the nation, Gordon Marketing has a niche unto themselves and has attracted agents that value face-to-face and relationship-based support and training. 

Sylvia teaches Continuing Education across the nation and is a sought-after speaker on Medicare, Agency Building, and Succession Planning for Insurance Agents. With a law degree from the Brandeis School of Law, Sylvia began her career in Estate Planning and swore to her family that she would never go into insurance! Since that bold statement, she not only became an insurance agent and continues to sell to this day, but she became one of the leaders in the life and health industry. She is currently on or has been in the past, several National Advisory Boards including AARP Medicare Supplements, United Healthcare MAPD, Aetna Medicare Supplements, Medico Insurance Company, Assurant Health, United Security Life, and Standard Life and Health.

In her free time Sylvia loves high adventure sports. She has four children ages 15-25 and her oldest is the third generation working at Gordon Marketing. Sylvia and her husband raise chickens, guineas, and pea fowl.

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