Impact of Observation Services

Monday, January 31, 2011 at 10:11:05 AM

At UHS, physicians and Care Managers work together to determine the appropriate level of care for patients. Admission status is based on medical judgement in conjunction with severity of illness and intensity of services required. In general, observation services are expected to be limited to 24 hours, but may be extended up to 48 hours, if the patient condition fails to improve as quickly as expected.

Medicare coverage differs for a patient receiving observation services versus “Inpatient status”. Observation services are billed under Medicare Part B and patients may be responsible for a deductible and co-pays for services received. Patients should be encouraged to contact Medicare directly in order to fully understand their particular coverage limitations. Traditional Medicare requires a “qualifying hospital stay” of 3 days in order to extend coverage for a skilled nursing facility. Observations services would not qualify them. However, other insurances may not require a qualifying hospital stay. Observation services do not impact a patient’s coverage for acute rehabilitation services and home care services.

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