Question

what criteria must be met to bill a Medicare patient as an inpatient and observation patient?

Answer 1

Medicare is the federal health insurance program includes hospital insurance, medical insurance and Medicare advantage plans.

Medicare inpatient criterias are;  

• An inpatient is a person who has been admitted to a hospital for bed occupancy for purposes of received inpatient hospital services.
• A patient is considered an inpatient if admitted and remains at least overnight and occupy a bed.
• Patient has all responsible to decide whether the patient should be admitted as an inpatient.
• Physician should order admission for patients who are expected to need hospital care for 24 hrs or more and treat other patients on an outpatient basis.
• It is not covered or non-covered solely on the basis of the length of time the patient actually spends in the hospital.

Medicare observation patients criterias are;

• Observation services are covered only when provided by the order of a physician or another individual authorized by State licensure law and hospital stall bylaws to admit patients to the hospital or to order outpatient services.
• Observation services must also be reasonable and necessary to be covered by Medicare.
• It is not a substitute for an admission or convenience.