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Outpatient Observation FAQ

1. What is outpatient observation?

Observation is a billing which permits patients who have problems (which normally do not qualify for a hospital stay) to be allowed to stay in the hospital for a “specified amount of time”.

2. What is the difference in billing?

An Observation stay is billed under outpatient services (under Medicare this would be under Part B) while inpatient admission is billed under inpatient services (under Medicare this would be billed under Part A Private Insurances may vary but most permit only 23 hours in observation.

3. What kind of problems do people have that would make observation appropriate?

Problems that can be treated in 24-48 hours or conditions for which the cause has not yet been determined.

4. What are some examples of these problems?

Some examples are nausea, vomiting, weakness, stomach pain, headache, kidney stones, fever, some breathing problems, and some types of chest pain.

5. What is meant by a “specified amount of time?”

Different insurance payors have different amounts of time that are covered in observation.

  • Medicare—observation services cannot exceed 48 hours. Typically a decision to release or admit is made within 24 hours.
  • Medicaid allows up to 30 hours.

6. What happens at the end of the “specified amount of time”?

Your physician will decide whether to release you from the hospital or to admit you as an inpatient.

7. What if my physician decides my condition requires inpatient care?

Your physician must then write an order to convert your outpatient observation stay to an inpatient admission.

8. What if my physician decides that I do not require an inpatient care?

If your physician decides that your care can be performed outside of the hospital you will be released, possibly with home health care services if necessary.

9. Can I be placed into outpatient observation after undergoing an outpatient surgical procedure?

Only if it is medically necessary. Medicare allows for a 4-6 hour “recovery period”. The intent of outpatient surgery is to have your surgery and be discharged the same day. However, if you experience a postoperative complication then your physician may place you into observation to monitor you further.

10. What type of post-surgical conditions may warrant further evaluation in “outpatient observation”?

  • Inability to urinate
  • Inability to keep solids or liquids down requiring IV feedings.
  • Inability to control pain.
  • Unexpected surgical bleeding
  • Unstable vital signs
  • Inability to safely walk after spinal anesthesia

11. What if I desire to spend the night after my outpatient surgery? Will Medicare cover this?

No, Medicare will only pay if there is a medical condition that warrants postoperative monitoring. If you desire to stay over for patient/family convenience, you will be fully responsible for payment.

12. What about “self administered drugs” and other services not covered by my insurance?

  • According to the billing rules for Medicare and Medicaid these charges will have to be billed to the patient.
  • Medicare and Medicaid will not pay for your pills or tablets and even some injectable drugs that fall under the category of self-administered. Please refer to the online version of the National Medicare Handbook at www.medicare.gov or call 1-800-633-4227 if you need more information.

A complete list of deductibles/services covered by observation/outpatient status is in your Medicare and You handbook.

If you would like to speak to someone regarding your financial responsibility as a result of this hospitalization, please feel free to contact our Patient Account Liaisons at ext.7689.

 
CAREER OPPORTUNITIES

Questions About Humana?

Dear Participant,

It has come to our attention that you may have recently received communication from Humana regarding UNC Lenoir Health Care's out-of-network status with its Medicare Advantage PPO plans.  We are concerned that information provided in that letter may have led to unnecessary anxiety or confusion for some members of our community.  Therefore, we are writing to you in an effort to clarify what out-of-network status with these plans means for participants.

 

First and foremost, it is important to note that all patients with Humana Medicare Advantage PPO plans may continue to be seen at UNC Lenoir Health Care. For many individuals, including those who have coverage through the North Carolina State Health Plan, no change should be apparent; your deductibles and copayments will not change, and benefits for in-network and out-of-network services are the same.

 

Participants in other versions of Humana's Medicare Advantage PPO plans may see increases in some copayments or deductibles, depending on the plan in which you are enrolled and the services you receive. As noted on Humana's website, "With a HumanaChoice (PPO) plan, you enjoy freedom to choose any doctor or hospital - but you pay less for services received from in network providers."

 

The following links may be helpful for those seeking to clarify the benefits offered by their plans:

Should you have further questions regarding your coverage, we would be happy to assist you.  Please call us at 252-522-7857 or 252-522-7676 Monday - Friday from 9:00 a.m. - 5:00 p.m.  Click on read more for Frequently Asked Questions.

We apologize for any concerns that information you have received from Humana may have caused. UNC Lenoir has been in continuous contact with Humana regarding our network status.  Our relationship with our patients and community is our highest priority, and we look forward to continuing to be of service to you and your family.

 

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New Year = New You! at the Minges Wellness Center

Special 2017 Minges Wellness Center Offer - New individuals who wish to join on Tuesday, January 10 between 8 am and 8 pm will NOT have to pay the $10 enrollment fee.  Membership is only $20 a month and no contract - ever. Call 252-522-7014 for more information.

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HealthLink - Fall 2016

Check out the latest edition of the Lenoir HealthLink! Download the PDF...

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UNC Lenoir receives bronze

UNC Lenoir Health Care is proud to be participating in the American Heart Association Get With The Guidelines Stroke program.  Participation ensures that our patients are receiving the most up-to-date evidence-based treatment to improve care and outcomes.  Get With The Guidelines Stroke program is an in-hospital program for improving stroke care by promoting consistent adherence to the latest scientific treatment guidelines.  Since its initiation in 2003, 1,656 hospitals have entered more than two million patient records into the Get With The Guidelines-Stroke database.  Numerous published studies demonstrate the program's success in achieving measurable patient outcome improvements. Hospitals receiving the Get With The Guidelines Bronze Performance Award have demonstrated a commitment to treating stroke patients with 85 percent or higher compliance to core standard levels of care as outlined by the American Heart/ American Stroke Association for 90 consecutive days.  "The Get With The Guidelines Stroke program has been a valuable tool for us to use to improve our stroke care.  We are proud to be a part of the American Heart Association's efforts to improve stroke treatment.  Being honored for excellent patient care is the best recognition a hospital can receive," said Dawn Becker, RN stroke program coordinator.  Hospitals also benefit from involvement with access to the most up-to-date research and scientific publications, professional education opportunities, clinical tools, patient education resources, staff support, performance feedback and national recognition for hospital team achievement.

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Be Informed About Mental Health Crisis Resources in Lenoir County

Mental Health Crisis:

24/7 Crisis Services for Lenoir County are available by calling Eastpointe Access Center at 1-800-913-6109 or for TTY-888-819-5112.  Customer Service  Specialists will assist you in finding a crisis provider.

Mobile Crisis Teams are available 24 hours a day.  Professional counselors will speak with you and your family during a visit.  They have an average response time of 2 hours.  This service is provided by Easter Seals - UCP 800-913-6109.

The crisis center in Lenoir County is provided by, PORT Human Services, located at 2901 N. Heritage Street in Kinston.  252-233-2383.  Appointments are not needed for crisis assessment and referral services, Monday - Friday 8 a.m. to 5 p.m.

Suicide:

To be connected to a skilled, trained counselor at a crisis center in your area 24/7 call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)

The 24/7 National Suicide Prevention Lifeline Network for Lenoir County is provided by REAL Crisis Intervention by calling 252-758-4357 for free couseling and extensive referral services.

Call 911 if there is a medical or life threatening emergency.

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2017 Colorectal Cancer Screening Dates

This free clinic is for men & women age 40 and up who have never been screened for or had colorectal cancer. The clinic will be led by members of the WellAware team and the UNC Lenoir Gastro staff. Screening sponsored by the Lenoir Foundation. Call 252-522-7014 to complete required registration.

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Overcoming Fitness Fears

Have you always wanted to get in shape but were afraid to try? There are countless excuses for failing to exercise or eat right. However, one of the biggest obstacles is not knowing where to start and being scared to take that first step. Join Brittney for this informative talk.

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Life After Stroke Support Group

Stroke survivors and caregivers, please bring your own experiences to a discussion with other survivors on life after stroke, transition from hospital to home, and re-entering the communtiy. It's FREE.  If you have had a stroke, or are a caregiver of a loved one who is struggling with stroke issues and would like to come for encouragement, join us.  The quarterly support group is led by UNC Lenoir Health Care Stroke Coordinator, Dawn Becker, RN, who may be reached for more information at 252-522-7575. 

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Avoiding Holiday Hang-ups

This program is for people with diabetes and pre-diabetes.  Sandra will offer meal planning tips, exercise suggestions, and ideas on how you might deal with sickness and/or avoid sickness during the holidays.  All advice is designed to help you have an enjoyable Thanksgiving and Christmas.  For more information contact Sandra Midyette, RN, CDE, at 252-522-7616.

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Your Blood Pressure: Reaching the Target 2016 classes

A one hour basic hypertension educational class for anyone who has higher than normal blood pressure and needs to understand the condition better in order to have good blood pressure control.  Class size is limited and credit for attendance requires the participant to be present for the full session. Registration must be done by contacting Gail Carraway at 252-522-7014. Dates and Times - Jan 11 at 2 p.m., Feb 9 @ 10 a.m., March 7 @ 10 a.m., Apr 12 @ 10 a.m., May 24 @ 2 p.m., June 13 @ 2 p.m., July 13 @ 2 p.m., Aug 29 @ 10 a.m., Sept 14 @ 1 p.m., Oct 12 @ 1 p.m., Nov 9th @ 1 p.m. and Dec 7 @ 1 p.m.

 

 

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