Are you Hospitalized? Inpatient or Under Observation?

Today we are finding that when in the hospital overnight your stay may be categorized as UNDER OBSERVATION rather than ADMITTED. You need to check with the Hospital’s Business Office what your status is, what your doctor has ordered, because it could make a very big difference should you require extended treatment after leaving the hospital. If your status is UNDER OBSERVATION, you are considered an OUTPATIENT, even if you are in a hospital room overnight.

MEDICARE counts INPATIENT days in the hospital, not UNDER OBSERVATION, so the designation will affect what you must pay the hospital and can affect whether you will qualify for Part A coverage in a skilled nursing facility post-hospitalization.

Hospital stays get shorter all the time and if time is needed to fully recover that care usually takes place in a skilled nursing facility. Medicare covers the cost of semi-private rooms, meals, skilled nursing and rehabilitation services and other medically necessary services and supplies, if you qualify.

To qualify for Medicare payment in a skilled nursing facility your INPATIENT stay must be a minimum of 3 days and the count begins the day the hospital formally admits you as an inpatient, based on your doctor’s orders, and does not include the day of discharge. Then you are qualified for Medicare payment in a skilled nursing facility, if admitted to the skilled nursing facility for the same illness or injury that necessitated the hospitalization under Medicare guidelines.

If you meet the criteria, Medicare will pay in full for the skilled nursing facility services for the first 20 days, before a coinsurance begins on the 21st day, so you can understand why it is so important to monitor your admission status when in a hospital.



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