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.
Hospital welcomes new physician
Michael Diamond, M.D., has joined the staff at Kinston Community Health Center. Diamond graduated from Wake Forest University with an undergraduate degree in Communications. He obtained his medical degree from the Brody School of Medicine at East Carolina University. He has a special interest in Pediatrics and Internal Medicine. Diamond completed his residency at Vidant Medical Center in Greenville, NC. He is single and he enjoys volunteering for community efforts such as sports physicals, health fairs, and legislation advocacy.LEARN MORE
Smith named PSEA of the Year
At the February Lenoir Memorial Board of Directors meeting, Chairman Ray Collier named Eveyln Smith, RN, Medical Oncology President's Service Excellence Award honoree for 2012. An excerpt from Smith's nomination read, "Evelyn Smith provides compassionate and quality care to the patients she servs on Medical/Oncolory on a daily basis. She exhibits outstanding interpersonal skills, which complement her ability to communicate in a clear, concise and accurate manner. when interacting with patients and staff. She has the ability to work very effectively and efficiently with cross funcational teams. She holds herself accountable high ethical standards and legal requirements setting an example to other staff." Congratulations Evelyln Smith!LEARN MORE
HealthLink - April 2013
Check out the latest edition of Lenoir HealthLink!LEARN MORE
New Care Giver Support Group
Meetings will be held the first Monday of each month beginning April 8 at 2 p.m. in the Neuse Room. This group is free of charge and intended to offer support to those who are caring for adults who are ill and/or elderly. Topics for meetings will be designed to address the emotional, physical, and spiritual health of the caregiver. Please contact Lisa James Coffman, MSW, at 252-527-3786 at Continuum Home Care & Hospice of Kinston for more details.LEARN MORE
McDaniel Sleep Center opens
The McDaniel Sleep Center, located near the Minges Wellness Center, was opened July 2 after this unused area of the facility was revamped. The center was named for the McDaniel family whose ancestors donated a home to be used as the first hospital in Lenoir County. The McDaniel’s granddaughter, Laura McDaniel Walker of Long Beach, Calif., made a generous donation and named the center in memory of the original donors, he said. “I’m grateful that (the family) thought of the idea to name the whole center,” Griffith said. The development of the new sleep center was partially funded by $180,000 in donations, said Dirk Griffith, director of the LMH Foundation Board. Each room has its own personality and exhibits a plaque designating a donor’s name. They look like typical bedrooms, but with state-of-the-art medical equipment in them. The rooms even feature a flat-screen television and are individually temperature-controlled. “The new suites have nice large bathrooms for each room,” Dail said.LEARN MORE
2013 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 Lenoir Memorial Gastro staff. Screening sponsored by the Lenoir Memorial Foundation. Call 252-522-7014 to complete required registration.LEARN MORE
Getting ready for flip-flops?
Are flip-flops really a good idea for people with diabetes? What about those exposed toes? Join Sandra as she shares information about routine foot care for individuals living with diabetes. Coe learn about the importance of self-exams, foot care and the potential complications uncontrolled diabetes can have on your feet.LEARN MORE
7 Ways To Get A Work-out On Vacation!
Vacations usually mean a two-week hiatus from physical activity and fitness but it doesn't have to. There are many ways that you can sneak in a work-out without disrupting the leisurely vacation that you have been craving all year. Join Tara and find out the 7 tips to keep you motivated while on vacation! Free to the public.LEARN MORE
Obesity and Diabetes
According to the Center for Disease Control, we are eating ourselves into a diabetes epidemic. Dr. Mitra shares how weight is tied to the functions of the pancreas and hormones. Free to the public - no registration required. Groups welcome!LEARN MORE
Obesity and Heart Disease
Your body is made up of water, fat, protein, carbohydrate and various vitamins and minerals. If you have too much fat — especially around your waist — you’re at higher risk for health problems, including high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. In this presentation, Dr. Mitra makes the connection with heart disease and high blood pressure. Free to the public - no registration required. Groups welcome!