Hospital Observation or Admitted

Hospital Observation or Admitted???

While not a new classification for patient care, there has been a marked increase in placing a patient under hospital observation rather than formally admitting an individual to the hospital as an inpatient. This is especially true if your health benefits are covered by Medicare.

Reasons for the Change

Under the current system, hospitals can be penalized by medicare with reduced reimbursements for certain diagnoses/conditions if a patient is admitted, discharged, then readmitted for the same problem in a limited period of time. This includes heart attack, pneumonia, and heart failure.

What You Need to Know

1.Any nights you are under observation do not count towards your Medicare post-hospitalization benefit coverage.

2.To qualify for full Medicare benefits following hospitalization (rehab or skilled nursing facility), you must be admitted to the hospital as an inpatient for at least 3 midnights.

3. If you are admitted as an inpatient under Medicare, you will pay a onetime deductible for all hospital services for the first 60 days you are hospitalized.

4. Medicare pays most of the physician services as an inpatient. After paying your Medicare B deductible, you will pay 20% of the medicare approved amount of the hospital bill.

What You Need to Do

1.If you are in the hospital more than a few hours, ask whether you are being treated under hospital observation or as an inpatient (have been admitted).

2. Continue to ask you status each day of your stay.

3. If you are able, bring someone to serve as your advocate: someone who can ask questions on your behalf, assist you during check-in and discharge.

4. Have your medication list prepared in advance: drug, dosage, frequency, who prescribed, and why you take the medication.

5.  Have your physicians and phone numbers available

6. Have a notebook and pen/pencil for writing down any questions you have and for recording your experiences while under hospital observation or admittance.

With all the changes that continue in the health care system, it is important that you are an active participant in your health care treatment, whether it is a visit to the doctor or the hospital. Have your pertinent medication information readily available. Have someone you know and trust ready to assist you when you are unable to act independently. Finally, become familiar with your health coverage benefits, whether Medicare or private insurance, before you need to use it.

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