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.
Jonathan Anderson named PSEA of the Year
On February 25 a Lenoir Memorial's monthly Board of Director's dinner, Jonathan Anderson was named Presdient Service Excellence Award honoree for 2013. President and CEO Gary Black read the nominations of all the quarterly finalists and explained the nomination process to those present. "The PSEA program is one that allows anyone - peer, supervisor, or manager - the opportunity to recognized an employee for exemplary service. Annually, we recognized about three worthy employees each month. These PSEA recipients gather quarterly at a luncheon where the PSEA of the Quarter is named, resulting in four quarterly finaists from which one is chosen as PSEA of the Year. This year the four finalists were Janet Tilghman, Gail Avery, Jonathan Anderson, and Sever Johnson."LEARN MORE
Personal Wellness Profiles
Ready to make a change? Get started with your personal wellness profile. For only $40 and a few minutes of your time, you can discover ways to make personal changes that can lead to improved health. Now's your chance to get a personalized comprehensive report about your overall health and well-being. Simply complete a four-page questionaire and have blood drawn for a cholesterol panel and blood sugar test. You will receive an overall wellness score based on a number of health indicators, as well as recommendations for improving your health. Sign up for your two-session evaluation by calling Donna Potter, RN, at 252-522-7815.LEARN MORE
The Minges Wellness Center is pleased to announce our growing relationship with Healthways, an independent insurance benefit provider for Silver Sneakers and other fitness program benefits. As a local gym participating in Healthways Prime, and now Silver Sneakers, we look forward to working with older adults who have this benefit on their insurance plans. Bring your Silver Sneakers benefit card and sign up today! Call 252-522-7207 for more information.LEARN MORE
Lenoir Memorial hosts blog
Lenoir Memorial has established a blog site to keep the public informed about all the news at the hospital. Please check out our blog site at www.lenoirmemorialhospital.wordpress.com
Let’s Go to the Grocery Store - summer foods and grilling
Come stroll the aisles of the grocery store with our registered dietitian as we explore healthy and delicious options for you and your family. This session will focus on tips for tasty summer foods and grilling selections. Registration is required as group size is limited. For more information or to register, please call Angie Doncaster, RD,LDN, CDE at 252-522-7471.LEARN MORE
Don’t Burn in the Sun skin safety campaign
More than 1 in 5 Americans will develop skin cancer during their lifetimes!
Join us as we observe Skin Cancer Awareness in May by providing educational materials about skin safety and skin cancer detection and prevention. Free sunscreen samples will be provided to the first 50 participants. And you can register to win a summer safety gift basket valued at $100!LEARN MORE
Tangling With Tumultuous Teens - tips for parenting teens
Have teenagers? You may be wondering about some of the very same things that other parents wonder - is my teen normal? Why does my teen keep secrets from me? And what if I'm feeling a little crazed too? This presentation can help provide insight into parenting techniques and proven tricks of the trade in working with the older child who is struggling for independence and external pressures. Gain information about coaching for behavior in a changing world of excesses and peer pressure. You are not alone and you were once a youth too!LEARN MORE
Free Mammogram Screening - for high risk women
Women that qualify receive a free screening mammogram and education about breast self-exam. To qualify, you must be a woman between the ages of 40 - 65, have no insurance to cover mammograms, and never have had a mammogram. Preregistration is mandatory. call 252-522-7014 between 8 a.m. and 4 p.m. Monday - Friday to schedule your apointment time. This screening is sponsored by Lenoir Memorial Foundation and Eastern Radiologists, Inc.LEARN MORE
Asthma, Allergies and Air Quality
Asthma is chronic disease that affects the lungs. It is the most common chronic disease amoung children and a primary reason for school absences. Asthma can be controlled by avoiding the triggers that can cause an attck and using medicine. This interactive workshop will teach steps for avoiding or reducing asthma and allery triggers in both the indoor and outdoor environments. For more information about this workshop contact Neasha Graves at 919-966-3746 or firstname.lastname@example.orgLEARN MORE