a patient is considered an inpatient to the hospital on admission
Process. 1  Call the Primary Children's Hospital Physician Access Line at (844) 662-1662 24 hours a day. 2  Referring providers will have a discussion with the Admissions Officer and Nursing Supervisor to facilitate direct admission. Can a patient be an “outpatient” anywhere in the hospital, even if they were told they were being admitted to the hospital? Yes. A patent can be receiving any service anywhere in the hospital (Radiology, Emergency Department, or nursing floor) and still be considered an “outpatient” according to CMS guidelines. The term “outpatient” is used by Medicare and other insurance companies for billing status only, not patient care status. The quality of care should be the same whether the Medicare patient is placed in observation or admitted as an inpatient. It is the difference in cost that is important to the patient. What an inpatient admission costs your patient. The patient will pay $812 (per benefit period) plus 20% of the Medicare-allowed amount. Call the Primary Children's Hospital Physician Access Line at (844) 662-1662 24 hours a day. Referring providers will have a discussion with the Admissions Officer and Nursing Supervisor to facilitate direct admission. Guidelines for hospital admission are given below. Guidelines are never a substitute for medical judgment, and each patient’s total clinical and psychosocial circumstances must be considered in their application. Therefore, there may be situations in which admission is appropriate, although the patient’s clinical profile does not comply with these guidelines. For example, inadequate family resources may dictate admission of newly diagnosed type 1 diabetic patients who otherwise do not meet the admission guidelines. Inpatient: A patient is admitted to a room for an overnight stay or for numerous days with continuous general nursing services in an area of an acute care facility. Examples of treatment areas for admission: ICU, Labor and Delivery, Cardiology Units or General Medicine Units. What does a Medicare patient pay as an “inpatient”? Medicare Part A (hospital insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in the hospital. Generally a person is considered to be in inpatient status if officially admitted as an inpatient with the expectation that he or she will remain at least overnight. The severity of the patient’s illness and the intensity of services to be provided should justify the need for an acute level of care. An inpatient admission solely because the patient has been kept in observation status over 23 hours would not be considered medically necessary. Emergency Department (ED): These units are within a hospital and provide initial treatment to patients with a broad variety of illnesses and injuries that could be life-threatening and require immediate attention, hospital admission or surgery. The ED is open 24/7 and is a major entry point for hospital inpatients. Clinic: Patients visit either a clinic or a physician office within a hospital and interacts with a physician or other healthcare provider. Patients may be referred to an outpatient unit for testing, admitted to an inpatient bed, or sent home following their visit.
Generally a person is considered to be in inpatient status if officially admitted as an inpatient with the expectation that he or she will remain at least overnight.