Inpatient vs Outpatient Hospital Status

An inpatient is a hospital patient who, in most cases, stays in the hospital overnight and meets a set of clinical criteria. Outpatients are people who receive care or hospital services and return home the same day. However, patients who need to stay at the hospital overnight for observation are often still considered outpatients.

When claiming Medicare and other insurance benefits, these distinctions make a difference. To make sure accurate information is filed with insurance providers, ERMC is now screening inpatient admissions for medical necessity and educating patients on whether or not they qualify for inpatient status.

Important Things to Know About Inpatient/Outpatient Status

The following is a general overview of things you should know regarding inpatient and outpatient information and your Medicare benefits:

• Staying overnight at the hospital does not automatically make you an inpatient.
• Inpatient/outpatient status is determined by your physician and your care team. Medicare does have the right to challenge this decision, however.
• Patients who stay at the hospital for observation are not considered inpatients.
• The severity of an illness or condition determines whether or not a patient can be called an inpatient.
• Medicare Part A covers hospital inpatient services, while Medicare Part B covers most physician inpatient services.
• Medicare Part B covers outpatient hospital and physician services, but you will generally have to make copayments for individual hospital services.

For more information, call us at 760-339-7100.
You can also visit www.medicare.gov to learn more about their policies.