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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

Lenoir Memorial Enters Exclusive Negotiations with UNC Health Care

The Board of Directors of Lenoir Memorial has unanimously voted to pursue exclusive negotiations to create a management services agreement with UNC Health Care, hospital officials announced today. Discussions regarding an affiliation began between the Lenoir Memorial board and UNC Health Care leadership earlier this year. The board recognized the extraordinary opportunity to partner with a flagship healthcare leader in the state - defined by excellence in research, clinical advancements and quality of care - was one not to be missed. It became clear that an agreement with UNC Health Care will best position Lenoir Memorial to create a stronger hospital for the Kinston community for generations to come.

"With this partnership, we have the opportunity to expand high-quality healthcare and a deeply respected brand to our part of the state.  We are confident this partnership will preserve the Lenoir Memorial legacy of local healthcare for future generations," said Gary Black, president and CEO of Lenoir Memorial Hospital.  "Adding access to UNC's groundbreaking research and focus on advancing clinical care and our commitment to the patients we serve enhances what we can deliver together, close to home."

The Lenoir Memorial Board now enters discussions with UNC Health Care to complete details of the agreement which the board hopes to finalize in April.  Both parties agree that when a contract between Lenoir Memorial and UNC HealthCare is finalized it will not involve any sale or exchange of assets and will allow the board to maintain local governance of the hospital.  Lenoir Memorial employees will keep their current positions and will remain employees of Lenoir Memorial, a private, not-for-profit hospital, not the state.

"We are pleased to affiliate with Lenoir Memorial Hospital and welcome them into our system," said William L. Roper, MD, CEO of UNC Health Care.  "This partnership combines the successful healthcare delivery at Lenoir Memorial Hospital will help advance our system's mission of providing excellent care, training the next generation of North Carolina's physicians, and conducting groundbreaking research."

This affiliation will allow Lenoir Memorial to provide a broader scope of resources and experience to benefit its patients.  some of the primary benefits include:

  • Expansion of locally available hospital and community-based patient care services to enhance patient care.
  • Improved patient experience and satisfaction.
  • Enhanced operational efficiency.
  • Recruitment of additional highly trained and skilled physicians.
  • Access to cutting-edge research and treatments at UNC Health Care.

Similarly, UNC Health Care entered into a management services agreement with Wayne Memorial Hospital in nearby Goldsboro, NC in December 2015.

For more information about Lenoir Memorial visit our website at www.lenoirmemorial.org

For more information about UNC Health Care visit their website at www.unchealthcare.org

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HealthLink - Winter 2016

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

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HealthLink - Fall 2015

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

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HealthLink - Winter 2015

Check out the latest edition of Lenoir HealthLink! Download the pdf

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Affordable Care Act and Healthcare Marketplace

Lenoir Memorial plays a vital role in educating uninsured patients about their coverage options and helping them navigate the Marketplace.  There are several ways to apply for health coverage.  You can apply online using a laptop or desktop computer.  (You may not be able to complete the application using a smartphone or tablet.)  You can also fill out a paper application, apply over the telephone or apply in person at certain sites.  Find out more about the different ways to apply here.  Certified Application Counselors (CAC) are available within Lenoir Memorial to educate consumers and aid them in completing an application for coverage.   If you have questions or wish to set up an appointment, you may contact Terrence Body, social worker at 252-522-7977, a patient accounts counselor at 252-522-7000 or call 800-318-8596 at any time of day, seven days a week.  Or visit HealthCare.gov.

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Brain Attack - Stroke Risks and Symptoms and the Importance of Early Treatment

Join Dr. Manasi Gahlot, Lenoir Neurology Neurologist, as she discusses the importance of realizing the symptoms of stroke and reacting quickly if you think someone is having a stroke.  If stroke is suspected think FAST: F - Face is uneven, A - Arm is weak, S- Speech is strange, T-Time to call 911.  This educational offering is free and groups are welcome!

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HealthyLife Weigh 2016 series

This weight management program focuses on weight loss goals supported by healthier nutrition practices and increased physical activity.  It is ideal for the individual needing to lose 10-40 pounds, and at a stage of readiness where lifestyle changes can be made. Nutrition education is delivered in a 4 week program led by a registered dietitian in the Minges Wellness Center at Lenoir Memorial.  The program is a modified form of the national program, HealthyLife Weigh, and focuses on the necessary formula for permanent weight loss: balancing calorie intake from food and calorie output through physical activity.  We will assist you in making permanent lifestyle changes to help you get to and stay at a healthy body weight.  This is not a diet but a new way of incorporating positive eating and activity habits. Each series consists of 4 classes that cover portion control, nutrition, grocery shopping, and emotional eating.  Participants will receive 2 months membership in the Minges Wellness Center with an individual exercise plan developed with an exercise specialist. Required registration may be completed by calling 252-522-7014.  Cost is $150.  Dates and times: Jan 6,13,20, 27 @ 8:30 a.m., Feb, 8,15,22, & 29 @4:00 p.m., March 10,17,24 &31 @ 12:00 p.m., Apr 6,13,20 & 27 @ 4:00 p.m., May 3,10,17,24 @ 8:00 a.m., Jun 1,8,15 &22 @ 12:00 p.m., July 7,14,21 & 28 @ 4:00 p.m., Aug 10,17,24, & 31@ 8:30 p.m.,Sept 6,13,20 & 27 @ 12:00 p.m., Oct 5,12,19,26 @ 4:00 p.m. and Nov 8,15,22 & 29 @ 8:00 a.m.

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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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Quit for Life Tobacco Cessation Program 2016 schedule

These 1 hour classes are limited in size and start promptly at the designated time.  You must be present for the entire session in order for it to be counted. Registration for each class must be done by contacting Gail Carraway at 252-522-7014.  All classes are on Thursdays and the cost is $25. 

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New Support Group - Life After Stroke

Stroke survivors and caregivers, please bring your own experiences to a discussion with other survivors on life after stroke, transitioning from hospital to home, and re-entering the community.  It's free.  If you have had a stroke, or are a caregiver or a loved one who is struggling with stroke issues, and would like to come for encouragement, join us.  This new quarterly support group will be led by Lenoir Memorial Hospital Stroke Coordinator Dawn Becker, RN, who may be reached for more information at 252-522-7575. The dates for the upcoming meetings are:  November 5, 2015, and in 2016 they are February 15, May 16, August 15, and November 21.  

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