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MEDICARE SECTION
Hospital Observation versus Admitted
If you’re staying overnight in the hospital, you’re an inpatient. If you’re at the hospital receiving care for the day, you’re an outpatient. Right? .... Wrong.
According to Medicare.gov, “You're an inpatient starting when you're formally admitted to the hospital with a doctor's order.” You’re an outpatient if you’re receiving services in the hospital–including ER care, observation services, outpatient surgery, lab tests, and any other care–when “the doctor hasn't written an order to admit you to a hospital as an inpatient. In these cases, you're an outpatient even if you spend the night in the hospital.”
And yet when doctors make that key call, they’re initiating potentially major financial consequences for the patient.
More importantly, Medicare (Part A) will only cover care at a skilled nursing facility (SNF) if the patient was admitted to a hospital (i.e., as an inpatient) for at least three days and then discharged to the SNF. (Most Medicare Advantage, Part C, plans waive the 3 day requirement).
Unfortunately, there’s incentive for hospitals to lean toward observation rather than admittance. Under the Medicare Fee for Service Recovery Audit Program, hospitals might lose their reimbursement if Medicare finds that they admitted someone who didn’t medically need to be admitted. As a result, hospitals tend to err on the side of observing patients if there’s initial doubt that they need to be admitted.
READ THE FULL ARTICLE, taken from the CSA Blog
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