How observation and inpatient hospital status affects Medicare coverage
If you’re wearing a hospital gown and lying in bed in a hospital room, it might seem logical to assume that you’ve been admitted to the hospital. However, this assumption could be wrong. You might actually be in the hospital with an observation status, which can dramatically affect your coverage during and after your stay. Knowing the difference between inpatient and observation status is important to understand.
Observation status
If you go to the hospital emergency room or are at the hospital for outpatient surgery, lab tests, X-rays or other services, you are most likely there on an observation status. Sometimes, you may even stay overnight or several nights in order to complete tests yet still be under observation instead of being an inpatient. Unless the doctor writes an order to admit you to the hospital, you are considered as a patient for observation. Admitting someone to the hospital is a complex medical decision so doctors sometimes require testing to be completed first in order to address the medical issues properly.
Inpatient status
When the doctor writes an order to admit you to the hospital, you are considered inpatient. In most cases, an inpatient status is appropriate if you are expected to need two or more days of medically necessary care. When counting the days of a hospital stay, the first day you are formally admitted is considered day one but the day you are discharged is not considered a full day.
Why status is important
The patient status can affect insurance coverage in two main ways. To begin, if you are in the hospital for observation, fees are treated in a different way. For example, MedicarePart B will cover the observation services but you will be charged a co-payment for each individual service unless you have a Medicare supplement which may cover the co-payments.
Secondly, status will also affect your level of care following the hospital stay. Medicare will only cover care in a post-hospital rehabilitation center or a skilled nursing facility if you have been a hospital inpatient for three consecutive days (or specifically, after three consecutive midnights). Days spent in the hospital under observation status will not count toward this three-day minimum.
Questions to ask
It is reasonable to ask about your status while in the hospital. One of the first questions to ask is, “am I inpatient or observation status?” Do not assume that if you are placed in a room, you have inpatient status. The next question to ask is “how long do you expect my stay to be?” Although the answer to this may change, you should still ask so that you have an idea. Finally, ask if you will need specialized skilled or rehabilitation services when you leave the hospital. Having this information makes it possible to plan ahead instead of being surprised later.
Rights as a patient
It is easy to be intimidated by the busy hospital staff but you do have the right to get information about your care. To begin, you should understand treatment options and be allowed to be part of the treatment decision. You should also understand what your Medicare and other health care coverage will be for services and prescription drugs. Finally, if you disagree with a decision, you can ask for a review. So if you feel you are being discharged too quickly or that your care is not as expected, you are entitled to discuss it with hospital staff.
After a hospital stay
If you had an observation hospital stay for less than three consecutive midnights — whether it was for a joint replacement, an elective surgery or an unexpected medical event — recover quickly and comfortably at Whitehall of Deerfield, the North Shore’s premier post-hospital rehabilitation center. During your post-observation stay, you’ll receive one-on-one physical, occupational or speech therapy delivered by in-house therapists; personalized around-the-clock nursing care and expert discharge planning to ensure you return home safely.
Whitehall of Deerfield is accredited by the Joint Commission on Accreditation of Healthcare Organizations, the nation’s most respected health care accrediting group and has earned the “Gold Seal of Approval® Certification for Post-Acute Care” and Accreditation for Nursing Care “National Quality Approval Seal.” This certification and accreditation reflects the focus on care provided at Whitehall of Deerfield.
Whitehall of Deerfield has also received Medicare’s highest rating in Medicare’s five-star rating system of nursing and rehabilitation centers, reflecting Whitehall of Deerfield’s outstanding clinical care and outcomes.
You can be assured of consistent and compassionate care at Whitehall of Deerfield where there is a board-certified medical director, experienced therapist and round-the-clock nursing care. State-of-the art rehab gyms filled with specialized equipment can help move you quickly to your highest level of functioning and independence. A full-time respiratory therapist is on staff to help with providing necessary treatments. Wound care and all other medical needs are monitored and treated as needed.
Whitehall of Deerfield also offers world-class accommodations and amenities to make your stay comfortable. Attentive concierge service, daily delivery of Starbucks coffee and newspaper to your room, valet parking for your visitors, Wi-Fi, and a Wellness Spa are just a few of the many services offered during a stay at Whitehall of Deerfield. Meals from a diverse menu can be taken in the privacy of your room or in the elegant dining room. Gourmet coffee, freshly-baked goods and ice cream refreshments are also available to all guests.
If your doctor recommends a stay in a rehabilitation center following a hospital stay, choose Whitehall of Deerfield where you can get the care you need and the luxury you expect. To learn more, visit whitehallofdeerfield.com or call 847-945-4600.