Medicare Requirements Regarding Admission Status and Their Consumer Impact
When a Medicare recipient is admitted to any hospital, a complex series of decisions and events can occur that Medicare patients should know about. These decisions can have an impact on access to care and your costs. Whether you are considered inpatient, outpatient, or observation affects how much you pay for your services. To help clarify, you are considered an inpatient when your physician has written a formal order for you to be admitted to the hospital. If you are getting emergency department services, outpatient surgery, lab tests, X-rays or observation services, then you are considered an outpatient.
Sometimes when someone requires hospitalization, the patient is listed in a status called “observation.” As an observation patient, you are not considered an inpatient, even though you receive the same medical oversight and nursing care as inpatients. Observation status is a physician order that is used when the diagnosis is not clear, and sometimes when your hospital stay is predicted to be less than the Medicare required two midnights to meet the benchmark of inpatient status. The best way to know what your status is–ask your physician.
If your physician decides you should be an observation patient, this can change your out of pocket costs. It is a good idea to bring your home medications for the nursing staff to dispense to you, otherwise this can create an out of pocket expense for medications that will not be covered.
Often, when nursing home or rehabilitative care is needed, a medically indicated three night inpatient stay can help qualify an individual for that benefit. Observation nights do not count toward the three night stay.
Hospitals will soon be required to notify you of your observation status within 36 hours of your hospital stay. A document called a MOON notice (Medicare Outpatient Observation Notice) will be given to you with the information you need to be more informed on these issues. If you have further questions, please refer to the Medicare website at www.cms.gov. Our Case Management team at MMH can also help guide you through the process while you are here.
Leann Tobin, Director of Marketing and Public Relations, MMH 240-7344