Inpatient or Outpatient? It’s important to know the difference
By Larry Weigel
Mrs. Jones, who recently joined Medicare, fell and was rushed to the hospital. While in the emergency room, her doctor told her he wanted to keep her in the hospital “for observation.” She was moved to a semi-private room and received an ID bracelet on her wrist and was served a meal later that day. The doctors recommended that Mrs. Jones go to a nursing facility for rehabilitation. When she was released from the nursing facility,much to her surprise, she was presented with a bill for the entire stay. She became upset and wanted an explanation. She was told that her doctor admitted her “for observation”, and not as an “inpatient.” Therefore, Medicare will not pay for her care.
Staying overnight does not mean you have been admitted as an inpatient. Mrs. Jones’ doctor failed to write a direct order stating that she should have been admitted as an “inpatient.” Medicare Part B helps cover expenses while in the hospital “for observation”. However, to receive coverage for any aftercare in another facility, you must have an “inpatient” status and must stay a minimum of three-nights in the hospital.
What a Medicare Beneficiary needs to know before going to a hospital:
- Always ask your current status. Am I being admitted for “observation”, or as an “in patient”?
- If your status is “observation”, ask for reconsideration.
- Your primary care doctor can influence your hospital status. If he/she feels you should be admitted as an inpatient, they may call the hospital and recommend it.
- Hospitals have a committee in place that can help determine your status and you have a right to request a committee review.
- If you have “observation” status and require skilled care upon dismissal, you can ask for “inpatient” reconsideration in order for Medicare to pay.
- A last resort, you can file a formal appeal with Medicare. Follow the appeal instructions on your initial letter of denial.
I’m pleased to announce that we have hired a full time Medicare Coach Program Administrator- Danielle Fisher-Arsenault who provided the research for this blog. Danielle is a nurse and will work closely with our members regarding Medicare issues including enrollment and prescription reviews. Already she has provided great value to our clients who are confused as they enter the Medicare maze of rules.
Please feel free to contact her at 785-537-0366.
