Inpatient vs. Observation Status While in a Hospital

Patients need to know if they are actually admitted into a hospital under Medicare Part A or are they just "in" the hospital facilities but under observation care status. 

Effective August 6, 2016 patients have to be told in writing if their stay is inpatient or observation.  President Obama signed the law one year ago in July 2015 but it's effective date does not apply until August 2016. 

This means that a patient is to be told, within 36 hours, the correct status of their hospital stay.  The patient then has a right to challenge that admission IF he or she did not receive the notice.  No other appeal rights are allowed as of the date this article was posted. 

As a patient you would not know the difference but the status of your admission,  "in-patient" versus "observation" status, is important.  First, after being "admitted" the patient is required to have a three day stay in the hospital past midnight to qualify for Medicare nursing home coverage.  Having a three day observation status does not qualify for a nursing home covered stay under Medicare. 

Second, without Part A benefits extended to the patient, many hospital charges, including certain drugs and biological sciences, may also not be covered.  Most  hospitals prohibit patients from bringing to the hospital prescription drugs.

To change the status, the physician must write "in-patient admission, discharged from observation."  The hospital case review manager should be asked to see if the patient qualifies for Part A in -patient benefits.

Don't be fooled, patients with post hip fractures have been placed in observation status rather than full part A admission benefits.  If a physician believes the patient needs to be in the hospital at least past midnight for two days, the physician should fully admit the patient as an inpatient stay. 

Remember, if a nursing home decides to discharge a patient before the 100 days of Medicare coverage expires, that decision can be appealed to the local quality improvement organization.  Every state has one and they must render a decision within 72 hours, and in most cases within 24 hours.