Determining your patient status at the hospital is not as straightforward as you would expect.  Hospitals are more frequently holding and treating some patients “under observation,” as outpatients instead of admitting them as inpatients. The question becomes: does the patient have inpatient or outpatient status? If the patient needs nursing home care after his hospital stay, outpatient status could prove costly.

What’s the Difference Between Being an Inpatient or Outpatient?

Outpatient treatment means that the hospital has not formally admitted the patient, and she is  “under observation.”  Those with inpatient status are officially admitted to the facility, and supposedly receive more intense attention from hospital staff.  In reality, there are not clear-cut differences between the two statuses. There is a great deal of overlap between the services. And to make matters worse, patients are not always aware when the hospital classifies them as outpatients.

Unfortunately, seniors may face great financial hardship if classified as outpatients instead of inpatients. If a patient needs nursing home care after her hospital stay and cannot show that she had inpatient status for at least three days, she will have to pay the entire cost of the nursing home. If the senior can show, however, that she was admitted for three days, then Medicare will pay for a certain number of days in the nursing home according to its regulations. This rule is not widely known and has caused major financial problems for thousands of senior citizens.

What are some possible solutions to this problem?  

First, ask daily about your patient status, and keep asking until you get a clear answer.  Second, if you ask to be admitted to the hospital and are refused, ask your doctor to advocate for you. Many doctors do not agree with the Medicare rule either and are likely to help you by writing a letter on your behalf, or by speaking to the hospital board that is in charge of determining which patients are admitted. Finally, lobby your lawmakers!  Many congressmen and women disagree with this Medicare rule, and there has been bipartisan support for altering it. It couldn’t hurt to contact your local congressperson’s office to share your concerns.

Don’t let patient status cost you thousands of dollars. If you have questions about the Medicare regulations, please give us a call. We’d be happy to help.

Start typing and press Enter to search