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What is observational status for someone in the hospital?

Posted: March 24, 2015, 12:14PM

Observation services are hospital outpatient services given to help the doctor decide if the patient needs to be admitted as an inpatient or can be discharged.  Observation services may be given in the emergency department or another area of the hospital.  Your hospital status affects how much you pay for hospital services and may also affect whether Medicare will cover care you get in a skilled nursing facility following your hosital stay.  You're an outpatient if you're getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services and the doctor HASN'T written an order to admit you as an inpatient.  In these cases, you are an outpatient even if you spend the night in the hospital.  According to the Medicare manual, a decision to admit is usually made within 24-48 hours.  Talk to your doctor or ask hospital staff about your status.  If you have a Medicare Advantage plan, check with your plan provider.  For more general information, read your "Medicare and You" handbook.  CMS publication "Are You a Hospital Inpatient or Outpatient?" also offers guidance. 


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