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.
Dr. Charles Moore joins staff
The Lenoir Memorial medical community would like to welcome Dr. Charles Moore to the medical staff. Dr. Moore recently completed a fellowship in minimally invasive/ bariatric surgery at the ECU Brody School of Medicine. Prior to his move to Greenville he was an attending surgeon, trauma, critical care, and general surgeon at the Aria Health System in Philadelphia, PA. Dr. Moore is married to Lisa a professor at the Brody School of Medicine. They have two children. Dr. Moore may be reached at Lenoir Surgical 252-775-5999.LEARN MORE
HealthLink - Fall 2014
Check out the latest edition of Lenoir HealthLink! Download the pdf.LEARN MORE
Health Needs Assessment
Lenoir County Health Department and Lenoir Memorial Hospital are conducting a county-wide health assessment. Your opinions about our community are important to us. Please complete the 2014 Community Health Assessment survey located at this link https;//docs.google.com/forms/d/1aAOrM2yYy9LUs7uhbpQY8H3Ckxdizx6xL7dG02zRjw0/viewform?usp=send_form
Farmers Market pre-ordered deliveries at LMH
Join Chelsea Sutton from Natures Touch Farm in LaGrange as she explains the pre-order process and describes products available from local farmers that will make access to fresh, local, and organic options easy for pick up at LMH. Pre-order online every other week for pick up on alternate Tuesdays outside the Minges Wellness Center. Pre-ordering online opens July 14. Information session are on July7 and July 10 at 1 p.m. at the Minges Wellness Center in studio A.LEARN MORE
Lenoir Memorial receives $282,898 grant from The Duke Endowment
Lenoir Memorial has received a $282,898 grant from The Duke Endowment to fund the development of a primary stroke center. The grant will be used to develop a comprehensive program that will stabilize the treatment stroke patients including initial acute care. Program components will include prevention, treatment, and post-care follow-up. Constance Hengel, director of Community Programming and Development states, "Death rates from stroke in eastern NC are among the highest in the state and the nation so better stroke outcomes are the goal in this intervention. Rapid recognition of stroke and reduction of time from event to treatment will be a major focus in the project. Time is brain and every minute counts for someone having a stroke. Our hope is to help the community becomes more aware of stroke symptoms and improved recognition and time for getting affected residents to our hospital quickly so we can provide rapid treatment."LEARN MORE
Join Dr. Geeta Katwa, Carolina Regional Arthritis and Rheumatology, PA for a community education presentation on Gout. If you have Gout, then you know that Gout presents with sudden, severe attacks of pain, redness and tenderness in joints, most often the joint at the base of the big toe. Dr. Katwa will field questions and help you understand the complex arthritis that is Gout.LEARN MORE
Pumkin: from pizza to pie and everything in between
We all know that pumpkins make great jack-o-lanterns and yummy pies. But did you know that pumpkin as a food has many versatile uses? Did you know it is a nutritional powerhouse and offers many health benefits? Come join our Registered Dietitian, Angie Watson, RD, LDN, CDE, for a sampling of tasty pumpkin recipies, and learn about the many nutritional benefits of pumpkin.LEARN MORE
Keeping a happy heart: Tips on how to stay heart healthy!
Take a look at your to-do list today. Do you have "get heart healthy" listed? If not, you should! According to the Centers for Disease Control, heart disease is the number one cause of death in the United States. Come join Graham as he discusses heart healthy tips to reduce your risk for heart disease.LEARN MORE
Learn the moves of the THRILLER DANCE
The exercise experts at the Minges Wellness Center will be teaching Michael Jackson's THRILLER dance during the month of October. One of his all time greatest hits, it is something that no one can resist grooving and moving to and it's easy! There will be a variety of workshops offered all leading up to a final class showcasing the dance on Halloween day, Friday, October 31 at 12 Noon at Lenoir Memorial. Call 252-522-7207 or 252-522-7944 for more details on how you can participate.LEARN MORE
Lenoir Memorial and CINTAS Document Management are sponsoring a community-wide SHRED EVENT. CINTAS will be on hand for community members to safely and confidentially destroy personal and home paperwork and documents through a shredding disposal method. No cardboard accepted.LEARN MORE