Q&A: Outpatients receiving observation services

April 23, 2018
Medicare Web

Q. Under what circumstances would it be appropriate for a patient who does not meet inpatient criteria to be registered as outpatient receiving observation services?

A. A patient who does not meet inpatient acuity criteria might still qualify to be registered as an outpatient receiving observation services. Patient access staff must understand the general concepts of this status to help them identify questionable admissions and understand the importance of tracking observation patients for admission or discharge within 24 hours. Most observation patients originate either as direct admit patients, prescheduled admits, or admitted though the emergency room.

Observation services may be appropriate in the following circumstances, and care must include active assessment of their condition during the observation period:

  • Patient evaluation for possible inpatient admission
  • Treatment that is expected to last 24 hours or less
  • Resolution of medical complications following outpatient surgery or procedures

Observation status is not appropriate for the following circumstances:

  • It cannot substitute for an inpatient admission
  • It cannot substitute for normal post-procedure recovery time
  • It cannot be used for patients awaiting nursing home placement or for convenience purposes
  • It cannot be used for routine procedure preparation

For more information, see The Complete Patient Access Handbook.

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