1. What is outpatient observation?
Observation is a status that allows patients to stay in the hospital for a “specified amount of time” when they do not meet inpatient criteria.

2. What is meant by a “specified amount of time?”
A specified amount of time for Medicare outpatient observation services should not exceed 48 hours. Typically, a decision to release or admit is made by your doctor within 24 hours.

3. What happens at the end of the “specified amount of time?”
Your doctor will decide to release you from the hospital or admit you as an inpatient.

4. What kind of problems do people have that make observation appropriate?
Observation may be appropriate for medical problems that can be treated in 24-48 hours or for conditions for which the cause has not been determined. Your doctor will decide based on your condition. Some
examples include, but are not limited to:
• Kidney stones
• Fever
• Weakness
• Nausea
• Stomach pain
• Vomiting
• Some types of chest pain
• Some breathing problems.

5. What happens when my doctor decides my condition requires inpatient care?
Your doctor must write an order to change your outpatient observation stay to an inpatient admission.

6. What happens when my doctor decides that I do not require acute inpatient care?
When your doctor decides that your care can be performed in a less acute setting (not a hospital setting), you will be released from the hospital.

7. What happens when my doctor decides to keep me more than 48 hours in outpatient observation status?
Medicare covers up to 48 hours of an outpatient observation stay. All charges incurred after 48 hours of an outpatient observation stay will become your responsibility. You will be asked to sign an Advance Beneficiary Notice (ABN) stating
that you are responsible for payment of any charges incurred after 48 hours.

8. What is the difference in billing?
An observation stay is billed as outpatient
services (a Medicare Part B service), while full inpatient admission is billed as inpatient services (a Medicare
Part A service).

9. Can I be placed into outpatient observation after undergoing an outpatient surgical procedure?
Only when it is medically necessary. Medicare allows for a 4-6 hour
“recovery period.” The intent of outpatient surgery is to have your surgery and be discharged the same day. Any period of time greater than the recovery period may place you into outpatient observation status.

10. What type of conditions after surgery may require further evaluation in “outpatient observation?”
When you experience a complication after surgery, then your doctor may place you in outpatient observation for continued monitoring. Complications may include, but are not limited to the following:
• Inability to urinate
• Inability to keep solids or liquids down requiring IV feedings
• Inability to control pain
• Unexpected surgical bleeding
• Unstable vital signs
• Inability to safely ambulate after
spinal anesthesia.

11. What happens when I want to spend the night after my outpatient surgery?
Will Medicare cover this?
No, Medicare will only pay when there is a medical condition that requires monitoring after surgery. When you want to stay for patient/family convenience, you will be fully responsible for payment.

For more information, call North Oaks Case Management at (985) 230-6312.