Wellness

[Mindy D]

Explain admitted for observation versus admitted as a patient please. This is for Medicare. I know this was explained here some time ago. 

If someone is in the er and then in a room is that under observation if they are in a room for three days? 

Does the observation thing convert to as a patient once admitted to a room? 

How does this thing work?

Please explain this thing to me. 

[CelticCrafter]

Under observation is not covered by insurance unless it results in being admitted.

[Mindy D]

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@CelticCrafter wrote:

Under observation is not covered by insurance unless it results in being admitted.

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@CelticCrafter @If you do get admitted do they then cover whatever they did to u while under observation?

If you are in a room for three days does that mean you were finally admitted?

What does it mean if they have u sign a document while in the ER? U came in the ER at 11 pm on the 23rd and u stay there on the 24th they have you sign some document and they do tests and then later on the 24th they give you a room and you are still in a room now, on the 26th?

@Carmie 

[Mindy D]

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@CelticCrafter wrote:

Under observation is not covered by insurance unless it results in being admitted.

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@CelticCrafter @How do you know if you are admitted? I know this sounds stupid, but are they supposed to formally tell you? 

[Still Raining]

Observation is a dedicated unit, often indicated on the license, for a type of subacute care.  There are written guidelines (clinical) for admission and discharge.

Basically you are not sick enough to be admitted and too sick to go home.  It does have time limits.

In smaller hospitals it can also be used as a late night recovery room, in which case you will be admitted.  Some rural hospitals may switch the beds over to SNF as needed.

I have never heard of any insurance that will not cover this care.

[CelticCrafter]

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@Still Raining wrote:

Observation is a dedicated unit, often indicated on the license, for a type of subacute care.  There are written guidelines (clinical) for admission and discharge.

Basically you are not sick enough to be admitted and too sick to go home.  It does have time limits.

In smaller hospitals it can also be used as a late night recovery room, in which case you will be admitted.  Some rural hospitals may switch the beds over to SNF as needed.

I have never heard of any insurance that will not cover this care.

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@Still Raining it's listed right in the Medicare and You handbook that it won't be covered.

[Josmad]

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@CelticCrafter wrote:

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@Still Raining wrote:

Observation is a dedicated unit, often indicated on the license, for a type of subacute care.  There are written guidelines (clinical) for admission and discharge.

Basically you are not sick enough to be admitted and too sick to go home.  It does have time limits.

In smaller hospitals it can also be used as a late night recovery room, in which case you will be admitted.  Some rural hospitals may switch the beds over to SNF as needed.

I have never heard of any insurance that will not cover this care.

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@Still Raining it's listed right in the Medicare and You handbook that it won't be covered.

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@CelticCrafter wrote:

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@Still Raining wrote:

Observation is a dedicated unit, often indicated on the license, for a type of subacute care.  There are written guidelines (clinical) for admission and discharge.

Basically you are not sick enough to be admitted and too sick to go home.  It does have time limits.

In smaller hospitals it can also be used as a late night recovery room, in which case you will be admitted.  Some rural hospitals may switch the beds over to SNF as needed.

I have never heard of any insurance that will not cover this care.

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@Still Raining it's listed right in the Medicare and You handbook that it won't be covered.

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Medicare part A will not cover it since Part A only pays inpatient services. Medicare Part B will pay for it as outpatient. 

[skatting44]

@CelticCrafter 

  your statement is not totally correct, as another poster  added clarification as to what Medicare part A and B cover. Private insursance companies such as Blue Cross  ect Do  cover  some part  of the 23 hrs observation status bill   minus whatever copay deductible you have .

[skatting44]

@Mindy D 

 yes, hospitals make it clear to patients  as to if they are being placed on 23 hr observation  or are being admitted .  If a  patient does not meet discharge criteria  after the 23 hrs ( Medicare part B or private insursance )  , then  the 23 hr billing ends and new billing ( under Medicare part A  or private insurance )  begins as a regular inpatient .

[Still Raining]

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@Mindy D wrote:

Explain admitted for observation versus admitted as a patient please. This is for Medicare. I know this was explained here some time ago. 

If someone is in the er and then in a room is that under observation if they are in a room for three days? 

Does the observation thing convert to as a patient once admitted to a room? 

How does this thing work?

Please explain this thing to me. 

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@Mindy D 

I don't keep track so much anymore, but I think the latest Transmittal came out in 2017 or 2018.  Check the CMS Manuals, perhaps under Claims Proccessing?

Search for MOON type items.  Indeed that is a thing 😁