Inpatient Vs Outpatient Hospital Status
What’s the Difference & How Does it Affect Me?
An inpatient is a hospital patient who (in most cases) stays in the hospital
overnight and meets a certain set of clinical criteria. Outpatients are
people who receive care or hospital services and return home the same
day, though patients who need to stay at the hospital overnight for observation
are often still considered outpatients.
When claiming Medicare and other insurance benefits, these distinctions
make a difference. In order to make sure accurate information is filed
with insurance providers, ERMC is now screening inpatient admissions for
medical necessity and educating patients on whether or not they qualify
for inpatient status.
Important Things to Know About Inpatient/Outpatient Status
The following is a general overview of things you should know regarding
inpatient and outpatient information and your Medicare benefits:
- Staying overnight at the hospital does not automatically make you an inpatient,
- Inpatient/outpatient status is determined by your physician and your care
team. Medicare does have the right to challenge this decision, however.
- Patients who stay at the hospital for observation are not considered inpatients,
- The severity of an illness or condition determines whether or not a patient
can be called an inpatient.
- Medicare Part A covers hospital inpatient services, while Medicare Part
B covers most physician inpatient services.
- Medicare Part B covers outpatient hospital and physician services, but
you will generally have to make copayments for individual hospital services.
For more information, call us at 760.339.7100. You can also visit
Medicare.gov to learn more about their policies.