Inpatient or Outpatient: Your Hospital Status Matters

Seniors covered by Medicare need to be aware of their hospital status for any hospitalization. You need to ask, ”am I an Inpatient or Outpatient?”

Here’s why. Observation status is the classification patients are given before they are formally admitted to the hospital. It provides doctors with time to decide whether to admit a patient as an inpatient or discharge them. You can be classified as observation status regardless of whether you are in the emergency room, having outpatient surgery or staying in a regular hospital room. While you are under observation status, you remain an outpatient.

Problems arise because observation status affects how much you pay for hospital services, like x-rays, drugs and lab tests. It can also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay.

For a patient who meets Medicare’s three-day inpatient hospital stay requirement and qualifies for Part A coverage, Medicare will pay for 100 percent of their skilled nursing care for the first 20 days and then all but $167.50-per-day co-insurance for days 21-100. However, under Medicare rules, the days spent as an outpatient under observation status do not count toward the three-day hospital stay requirement.

In March, 2017, Congress enacted a law requiring hospitals to inform patients both orally and in writing within 36 hours that they are in the hospital “under observation.”  However, patients and their families are often under stress and do not realize the financial implications of this classification. A number of bills have been introduced in Congress over the past several years that would require Medicare to count the time a Medicare patient spends in observation status toward the three-day inpatient requirement to qualify for coverage of skilled nursing care. 

There are no clear cut solutions. At this time, there is no process for appealing observation status. Many patients who find themselves in this situation ask their personal physician to intercede and try and get a patient’s status changed. Others pay out of pocket for their services. Many simply go without care.

If you have questions concerning life, health, Medicare Supplement Insurance, Medicare Advantage plans or other insurance questions, please contact me at 440-255-5700 or  I will help you get the best coverage to meet your needs.  

Laura Mutsko

Laura Mutsko is a licensed insurance broker offering a complete line of health and life insurance products, including Individual, Group and Family Health, Medicare Advantage Plans, Medicare Supplement Plans, Medicare Part D Prescription Coverage, Vision, Dental and Life Insurance. Mutsko Insurance Services, LLC is located at 6982 Spinach Drive in Mentor, Ohio.

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Volume 9, Issue 3, Posted 11:09 AM, 03.10.2018