Table of ContentsView AllTable of ContentsHow Long Is a Stay?Types of AdmissionAdmission Status DeterminationDealing With Insurance
Table of ContentsView All
View All
Table of Contents
How Long Is a Stay?
Types of Admission
Admission Status Determination
Dealing With Insurance
If you receive medical treatment that involves an overnight hospital stay, you are being treated on aninpatientbasis. If you are treated in a hospital but don’t need to stay, you are being admitted on anoutpatientbasis.
In between, a person may receive treatment and be admitted to a hospital so they can be watched and reassessed to determine if further treatment is needed. This is admission on anobservationbasis.
This article explains when you need to be admitted on an outpatient, inpatient, or observation basis and how the decision is made.
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How Long Is Your Hospital Stay?
For the purpose of insurance billing, the length of a hospital stay is based on how many midnights you will spend in the hospital.It is not based on the number of hours you are hospitalized.
So, even if you are admitted at 11:00 p.m., you will be billed for one hospital day (along with any accrued charges) the second it turns midnight.
The hospital bill you receive is separate from the bill you receive from your surgeon oranesthesiologist. The bill not only includes the daily room charge but also charges for food, medical supplies, medical services, and any tests or procedures, such as X-rays.
How to Pack for a Hospital Stay
Definitions of Hospital Stays
Specific definitions are assigned to your admission status, some of which are not as straightforward as they seem. The definitions matter because they have a direct impact on both your billing andout-of-pocket costs.
By definition:
In practice, the term “admitted” generally infers inpatient care but can be applied to anyone who is admitted for treatment in a hospital.
Insurance and How Admission Status Is Determined
If you require emergency care, the ER department will submit a specific CPT code after treatment designating the need for hospital observation. The code can be transitioned to inpatient care if it is decided that further treatment is needed after an overnight stay.
Asking About Overnight Hospital Bills
The amount you pay for a hospital stay is based on your insurance plan, including thedeductible. If you have private or employer-sponsored insurance, there may becopayment or coinsurancecosts you will need to pay out of pocket.
If out-of-pocket costs are a factor, there may be an outpatient procedure that can be used in place of an inpatient procedure. As long the treatment is appropriate and effective, it is a reasonable option to discuss with your healthcare provider.
For people withMedicare, outpatient services are covered as part of Medicare Part B, while inpatient services are covered under Medicare Part A. Medications may fall underMedicare Part D.
The same applies to other federal programs likeMedicaid,Children’s Health Insurance Program (CHIP),Tricare, andVeteran’s Health Administration (VHA).
On the other hand, if you have been discharged from the hospital and are confused about your bill, the hospital billing department can explain the charges and may be able to direct you to financial assistance if you foresee problems paying the bill.
What to Do If You Get a Surprise Hospital Bill
Summary
A hospital outpatient, inpatient, or observation status is about more than just how long you are in hospital. The definition of each can place you in a different category of billing.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Medicare and Medicaid Services.Billing and coding: acute care: inpatient, observation and treatment room services.Medicare.gov.Are you a hospital inpatient or outpatient?Centers for Medicare and Medicaid Services.Hospital outpatient quality reporting program.Centers for Medicare and Medicaid Services.Advanced copy- revisions to state operations manual (SOM) hospital appendix A.Centers for Medicare and Medicaid Services.Hospital coverage under Part B.American Medical Association.ICD-10.American Medical Association.CPT overview and code approval.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Medicare and Medicaid Services.Billing and coding: acute care: inpatient, observation and treatment room services.Medicare.gov.Are you a hospital inpatient or outpatient?Centers for Medicare and Medicaid Services.Hospital outpatient quality reporting program.Centers for Medicare and Medicaid Services.Advanced copy- revisions to state operations manual (SOM) hospital appendix A.Centers for Medicare and Medicaid Services.Hospital coverage under Part B.American Medical Association.ICD-10.American Medical Association.CPT overview and code approval.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Medicare and Medicaid Services.Billing and coding: acute care: inpatient, observation and treatment room services.Medicare.gov.Are you a hospital inpatient or outpatient?Centers for Medicare and Medicaid Services.Hospital outpatient quality reporting program.Centers for Medicare and Medicaid Services.Advanced copy- revisions to state operations manual (SOM) hospital appendix A.Centers for Medicare and Medicaid Services.Hospital coverage under Part B.American Medical Association.ICD-10.American Medical Association.CPT overview and code approval.
Centers for Medicare and Medicaid Services.Billing and coding: acute care: inpatient, observation and treatment room services.
Medicare.gov.Are you a hospital inpatient or outpatient?
Centers for Medicare and Medicaid Services.Hospital outpatient quality reporting program.
Centers for Medicare and Medicaid Services.Advanced copy- revisions to state operations manual (SOM) hospital appendix A.
Centers for Medicare and Medicaid Services.Hospital coverage under Part B.
American Medical Association.ICD-10.
American Medical Association.CPT overview and code approval.
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