Outpatient Observation Status

What does observation status mean?

We know hospital visits can sometimes be overwhelming, which is why we strive to deliver the highest-quality care in the shortest time possible.

If you’re placed under outpatient observation, you will probably stay in the hospital less than 48 hours as we conduct further testing and evaluation.

Whether you’re under observation status or not, you’ll receive the same high-quality care from Ballad Health. Being in outpatient observation absolutely does not affect the quality of services you receive.

What does insurance cover?

Some insurance providers have different copay and deductible levels for inpatient and outpatient observation stays.

If you have Medicare, your outpatient observation stay, as well as any post-hospital rehabilitation or a skilled nursing care, is covered under Medicare Part B, which has a different deductible.

To determine your exact level of coverage, check your policy or contact your insurance provider.

Why am I not an inpatient?

Hospitals are required to evaluate several factors – such as severity of illness, anticipated length of stay and planned procedures – before admitting a patient. And the decision to place patients in outpatient observation status is determined by a fairly strict set of guidelines. It isn’t a choice the hospital or your doctors make on their own.

That’s why you might actually be considered an outpatient, even if you stay in the hospital overnight.

In fact, Medicare penalizes hospitals for inpatient admissions that federal contractors determine should have been observation stays. These contractors make their decisions by reviewing your hospital medical record, even though they have never met or treated you. And sometimes, that can happen a year or more after your hospital visit.

Hospitals that fail to comply with this policy can be accused of and charged with fraud.

Helping ensure you receive the most appropriate care

It’s very important to communicate regularly and openly with your entire care team throughout your hospital stay. The more we know about you, the better we’ll be able to provide your care and And being admitted as an inpatient when you’re eligible is one reason (among many) for that.

Stay updated on your status.

Ask your physician whether you’ve been admitted as an inpatient and ask for an update each day. Your admission status might change from one day to the next, so it is important to get updates.

Be open with your doctors.

To help justify an inpatient admission, which is likely to be more fully covered by your insurance, it’s important your physicians know everything about your condition and medical history – even if you're unsure if it’s relevant.

Federally contracted companies might review your medical record to determine whether or not your visit qualifies as inpatient or outpatient observation. Any lack of documentation can lead to denied coverage.

And if your providers don’t have a complete picture of what’s going on with your injury or illness because you didn’t share everything you should have, that’s much more likely to happen.

Talk to the case manager.

Discuss your situation with the hospital case manager. Your doctor and case manager will do everything they can, in compliance with federal rules, to justify your admission as an inpatient.

Stay involved

Whether you’re an inpatient, outpatient or have already been discharged, it’s important to stay actively involved in your care.

If you have questions about outpatient observation status or your care plan, please talk to your care team. They’ll be happy to help.