Author Topic: Overnight Observation: Outpatient or Inpatient Stay  (Read 4132 times)

cohenmk

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Overnight Observation: Outpatient or Inpatient Stay
« on: July 28, 2008, 03:29:19 PM »
I am having a brain fart.....when admitted for overnight stay after a (supposedily) outpatient procedure, is the observation coded as an outpatient or inpatient POS...if inpatient (POS 21), does the procedure itself become an inpatient as well??  I should know this but it has been awhile coding hospital procedures...and I have myself confused....  :-\

Michele

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #1 on: July 28, 2008, 07:18:10 PM »
Hi,

    I take it you are billing for the Dr's professional fees right?  I was always told that if you went over a certain number of hours it was considered inpatient so I would think the POS would have to be 21. 


Michele
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cohenmk

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #2 on: July 29, 2008, 07:09:08 AM »
Thanks for the answer...do you happen to know offhand how many hours is considered inpatient stay?? Thanks for all your help...and yes, this is for the Physician's professional component.

Michele

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #3 on: July 29, 2008, 07:43:56 AM »
I want to say 18 but I tried to verify it and couldn't find the info.  I haven't needed to know that in a very long time!  :)

Maybe somebody else knows for sure.

Thanks
Michele
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cohenmk

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #4 on: July 29, 2008, 08:09:31 AM »
I do believe I have found the answer in Medicare's MLM:

"Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation status is commonly assigned to patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge.
Observation services are covered only when provided by the order of a physician or another individual authorized by State licensure law and hospital staff bylaws to admit patients to the hospital or to order outpatient tests. In the majority of cases, the decision whether to discharge a patient from the hospital following resolution of the reason for the observation care or to admit the patient as an inpatient can be made in less than 48 hours, usually in less than 24 hours. In only rare and exceptional cases do reasonable and necessary outpatient observation services span more than 48 hours.

When a physician orders that a patient be placed under observation care, the patientís status is that of an outpatient. The purpose of observation is to determine the need for further treatment or for inpatient admission. Thus, a patient receiving observation services may improve and be released, or be admitted as an inpatient."

What I am gathering is that it will be dependant upon the patient's status (morbidity associated with the procedure), Physcian's orders/ medical judgement of the admitting physician. When the patient enters as outpatient, he is considered outpatient regardless of hour he came in, whether he used a bed or remained in the hospital past midnight...unless determined otherwise, ie., a valid order to admit as inpatient.

Michele

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #5 on: July 29, 2008, 11:40:35 AM »
Based on that it looks like your POS should be 22.  Thanks for sharing the info.

Michele
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jerrlin

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #6 on: April 24, 2009, 01:42:56 PM »
Who's responsibility is it to notify the patient that his or her status has changed from Hospital admittance,to Observation Status. Insurance does not cover co pays if you are an outpatient. Therefore the patient would be without knowing responsible for many $$ in co pays. Is this not a question of patients rights and ethics ? 

Pay_My_Claims

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #7 on: April 24, 2009, 06:21:04 PM »
Observation can vary....rule of thumb is it is >=23hrs, but you can have observations up to 48 hrs before you have to admit or discharge.

PMRNC

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #8 on: April 24, 2009, 07:45:59 PM »
Quote
Who's responsibility is it to notify the patient that his or her status has changed from Hospital admittance,to Observation Status. Insurance does not cover co pays if you are an outpatient. Therefore the patient would be without knowing responsible for many $$ in co pays. Is this not a question of patients rights and ethics ?

It depends on the medical status of the patient, the hospital USUALLY will cert the admission, if not usually plans allow for 48-72 hours after discharge to certify inpatient. My plan benefits say I am ultimately responsible but when I was in hosp last year the hosp certified the stay.
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jerrlin

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #9 on: April 26, 2009, 03:40:52 PM »
Does the Dr. or facility have to notify the patient that they are an outpatient and not an inpatient, after being admitted ?? I read in the CMS that a patient was to be notified in writing.

Michele

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Re: Overnight Observation: Outpatient or Inpatient Stay
« Reply #10 on: April 27, 2009, 07:37:18 PM »
I think that is correct, the patient needs to be notified if the stay is in or outpatient.  I would think it would be the responsibility of the facility staff to notify the patient.

Michele
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