Your hospital status (“inpatient” or “outpatient/observation”) affects how much your insurance pays and what you pay for your hospital services ­– such as X-rays, 药物, 实验室测试, 等. 每种状态都有不同的共付额或保险比例. 如果你有医疗保险计划, your hospital status may also affect whether Medicare will cover your care in a skilled nursing facility (nursing home) following your discharge from the hospital.

你的医疗团队, 包括医生, 护理人员, 医院病例管理人员(利用管理), reviews the medical record for the clinical information and applies the research-based clinical criteria utilized by CMS that provides a recommendation for either “outpatient” or “inpatient” status.

Your physician determines the final status; however, 如果联邦医疗保险不同意这个决定, 医疗保险不会报销医院的费用. 医院的费用可能会由病人支付.

医生 and hospitals follow a specific set of clinical criteria (severity of illness and intensity of service needed to diagnose and treat) that assists in determining whether a patient meets medical necessity for an “inpatient” status in the hospital. 医疗保险中心 & Medicaid 澳门搏彩网首页网址 (CMS) has specific guidelines (medical necessity) on whether a patient should be Inpatient or Outpatient/Observation­ – depending on how severe the patient’s symptoms/condition is and how quickly they may respond to treatment.

“Outpatient” status is commonly referred to as patients who typically go to an outpatient department such as laboratory, 放射科或急诊科的诊断澳门搏彩网首页网址. Your physician may write an order for you to be admitted as an outpatient/observation patient at 澳门搏彩网首页网址. The observation stay is intended for short-term diagnostic testing and monitoring, 哪些是合理的评估你的状况. This is done in order to determine your need to be admitted to the hospital as a hospital patient or be discharged to go home.

Specific criteria (based on severity of illness and intensity of service) must be met in order to admit a patient to the hospital. 在某些情况下, it is not clear whether you are well enough to go home or if hospitalization is needed until further testing/evaluation is completed.

医疗保险A部分 (医院保险)包括住院澳门搏彩网首页网址. 一般, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in the hospital. If you are hospitalized again after 60 days, Medicare may apply another deductible.

医疗保险B部分 (medical insurance) covers most of your physician services when you’re an “inpatient.” You pay 20% of the Medicare-approved amount for physician services after paying the annual Part B deductible.

是的. 病人可以在医院的任何地方接受任何澳门搏彩网首页网址(放射科), 急诊科, 或护理楼层)，但仍然被认为是“门诊病人”,，根据CMS指南. The term “outpatient” is used by Medicare and other insurance companies for billing status only, 不是病人的护理状况.

医疗保险B部分包括门诊医院和医生澳门搏彩网首页网址. 一般, this means you pay a copayment for each individual outpatient hospital service. 此金额可能因澳门搏彩网首页网址而异.

有关医疗保险如何覆盖医院澳门搏彩网首页网址的详细信息, 包括保险费, 免赔额, 和共同支付, 访问 www.医疗保险.政府 查看联邦医疗保险 & 您的手册，或致电 1 - 800 -医疗保险 (1-800-633-4227).

如果你或你的家人在医院住了几个小时以上, always ask the physician or hospital staff if you’re an “inpatient” or “outpatient/observation” because it WILL affect how you are billed and what you will have to pay for out-of-pocket.

Medicare requires a “qualifying hospital stay” in order for Medicare A to cover care within a skilled nursing facility. A qualifying hospital stay is defined as a hospital “inpatient” for a minimum of three (3) days in a row – counting the day you were admitted as an inpatient, 但不包括你出院那天.

例如, a physician may have determined that a patient be on “outpatient observation” status to help decide whether the patient needs to be admitted to the hospital as an “inpatient” or whether they should be discharged. 在此期间, 病人仍然被认为是“门诊病人”,"即使是在接受医院澳门搏彩网首页网址的时候, 这可能包括多夜过夜.

如果你仍然处于“门诊观察”状态, 即使你在医院呆了3天, Medicare will not count this time toward the required 3-day minimum hospital stay for your stay in a Skilled Nursing Facility. 如果你准备好出院了, you may need to either pay part of your stay at a Skilled Nursing Facility or ask for other options for payment. The hospital discharge planner or Social Worker can assist you and your family with these decisions.

No. A patient status is only changed if they meet full “inpatient” medical necessity/severity of illness criteria.