title: Inpatient vs. observation: get it right the first time.
abstract: It's often a balancing act to determine if patients should be admitted to the hospital or receive observation services as an outpatient, but it's critical to get it right the first time so the hospital will get appropriate reimbursement and avoid having money taken away following audits. Reimbursement is much lower for observation services, but if a patient is admitted inappropriately, Medicare or other payers can take back the reimbursement. Patients receiving observation services as outpatients are subject to Medicare Part B co-pays. If the patient is later admitted, the time in observation doesn't count toward the three-midnight inpatient stay requirement for Medicare to pay for a skilled nursing home admission. One-, two-, and three-day stays are often targets of auditors. Case managers must work closely with physicians to help them determine the appropriate level of care. In certain circumstances, Condition Code 44 can be used to change a patient's level of care from inpatient to observation.
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D003657:Decision Making; D006760:Hospitalization / Q000191:economics*; D007349:Insurance, Health, Reimbursement; D016345:Medicare Part B / Q000191:economics; D036301:Qualitative Research; D014481:United States; D057832:Watchful Waiting