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.
LENOIR MEMORIAL HOSPITAL LAUNCHES SEARCH FOR STRATEGIC PARTNER
Kinston. NC—(December 4, 2013)— Lenoir Memorial Hospital officials today announced the launch of a process to search for a strategic partnership with another hospital, health system or hospital company with the goal to further strengthen and enhance healthcare services and better meet the needs of the community for the long term. Recently, Lenoir Memorial engaged an outside hospital consulting firm that spent a year learning about the organization, the way it operates, its finances and its culture. The firm conducted studies inside the hospital and in the community to understand what Lenoir Memorial is today – and what it can be in the future. At the end of its work, the firm found that in order to continue the 100-year legacy of excellent, high-quality care in the future, the hospital must consider partnering with another organization. “For a century, Lenoir Memorial has been a trusted, essential care provider for patients in Lenoir County and the surrounding region. We are a strong and profitable organization today, but the world of healthcare delivery is changing, so we are taking proactive steps to ensure continued growth and success to protect access to care close to home,” said Gary Black, president and CEO of Lenoir Memorial Hospital. The Lenoir Memorial Board is directing the partner review process with the assistance of Juniper Advisory, a Chicago-based financial advisory firm. The firm is a leading national transaction advisor to nonprofit community hospitals on partnerships in an era of accelerating consolidation. The systematic approach offered by Juniper will make certain that all options and types of partnerships are considered and that Lenoir Memorial’s opportunities are fully understood. The Board is in the process of generating several objectives that will guide its selection of a partner. These criteria will be identified and discussed by the Board, then finalized over the next several months. Confidential discussions with a number of potential partners will begin in spring 2014, with the process expected to take 12-21 months to complete once those discussions have begun, as a variety of partnership models will be explored. “We recognize that the way healthcare is provided today – where it is offered, how it is paid for, how it is measured – is changing dramatically,” said Ray Collier, chairman of the Lenoir Memorial Board of Directors. “Reimbursement for care is declining, the care itself is shifting to more convenient outpatient settings, and more emphasis is being placed on keeping people healthy, not just treating them when they are sick. Hospitals and health systems, as well as physicians, are partnering in order to meet these new demands.” “We believe now, when Lenoir Memorial is financially strong, is the right time to look for a strategic partner,” continued Collier. “We can evaluate our choices from a position of strength and allow ourselves time to conduct a thoughtful and thorough review on our own terms.”
HealthLink - Fall 2013
Check out the latest edition of Lenoir HealthLink! Download the pdf.LEARN MORE
New physician joins medical staff
C. Aitor Macias, MD, has joined Wayne Jarman, MD, at Lenoir Surgical. Dr. Macias completed his medical degree at the University of Buenos Aires in Argentina. He completed general surgery residencies at CEMIC, and the Robert Wood Johnson Unversity Hospital, a part of Rutgers Medical School, in Piscataway, NJ. He obtained his Masters in Public Health from the University of Pittsburgh and a fellowship in minimally invasive surgery at the University of California in San Diego. He performs the majority of his surgeries laparoscopically.LEARN MORE
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
Women and Heart Disease
The feminine side of a healthy heart will be discussed with Dr. Shyamal Mitra of Kinston Medical Specialists. Bring your questions. This free session is open to the public. No registration required.LEARN MORE
Your Doctor Says You Need A Heart Cath
Learn the potential risks and lifesaving benefits of heart catheterizations. Dr. Pradeep Arumugham of Kinston Medical Specialists will discuss heart caths as well as a new procedure being done at Lenoir Memorial when blockages are found in the heart. Free to the public, bring your questions! No registration required.LEARN MORE