Patient
Guide
Key Information for Your Stay
Observation Status
Observation Status
It is important for patients to know if they are classified as “inpatient” or “observation” status while in the hospital. This is particularly important for Medicare patients.
What is observation status?
Observation status is when a patient needs treatment or monitoring before the physician can decide about inpatient admission or discharge. This usually happens after a patient goes to the ER. It also can happen if the patient has complications after outpatient surgery or other procedures. The patient is given a room in the hospital while under observation.
What is the difference in billing between observation and inpatient status?
Observation is billed under Outpatient Services (under Medicare, this would be under Part B), while full inpatient admission is billed under inpatient services (under Medicare, this would be under Part A).
What types of medical problems would make observation appropriate?
Problems that can usually be treated within 24 to 48 hours, or conditions for which the cause has not yet been determined, would be appropriate for observation.
What are some examples of these medical problems?
Some examples include vomiting, weakness, headache, stomach pain, nausea, some breathing problems, fever, and some types of chest pain.
How long can a patient remain in observation?
Different insurance companies have different amounts of time that are covered under observation.
What if my physician decides that my condition requires acute inpatient admission?
Your physician must write an order to convert your observation status to an inpatient admission. This decision must be in agreement with the established guidelines used by the hospital and insurance providers.
What happens if my condition does
not require acute inpatient care?
If it is decided that your care can be performed in a less acute setting (not a hospital), you will be released, possibly with home healthcare, if necessary.
Can I be placed under observation after undergoing an outpatient surgical procedure?
The intent of outpatient surgery is that you have your surgery and go home the same day. However, if you experience a postoperative complication, your physician may decide to keep you in the hospital for further monitoring.
May I bring my medications from home?
Our policy does not allow you to use medications from home unless ordered by your physician. If medicine is required during your stay, your physician will prescribe it for you. If you brought medicine of your own, please send it home. If you are unable, please notify your nurse to have your medication from home secured during your stay in the hospital. If you have questions about this policy, please discuss it with your nurse or physician.
Will Medicare cover all my
payments the same as it would if I were an inpatient?
No, Medicare will cover your
expenses under your Part B benefits. Your outpatient co-pay will apply. Medicare also will not pay for routine drugs/medications, which are considered self-administered drugs. Self-administered drugs are generally those that are taken routinely. This means that you may be financially responsible for any medications you may take for chronic illnesses, such as high cholesterol, high blood pressure, diabetes, COPD, and asthma.
If you have questions, please call your case manager at
941.782.2422.