A lot people don't realize this, but a hospital admission is not an admission when you are on observation status. This is a Medicare guideline that was put in place to manage the cost of hospital admissions. The most expensive place to receive care is a hospital and you do not want to be there, and the organization paying your healthcare bills doesn't want you to be there either, if you don't have to be.
Being in a hospital bed in a nursing unit does not automatically qualify as a hospital admission. You may only be on observation status to evaluate whether you need in patient acute care. If the treatment you receive is for monitoring a condition that does not require intensive hospital care, you will not be admitted to the hospital. Medicare has healthcare professionals that review cases for “medical necessity” and if you are not sick enough to be admitted, the hospital will not be paid for their services.
Always ask about your status if you are sent to a hospital unit. Do not assume that you are admitted. You might ask your doctor to advocate for you, but the healthcare team all participate in the admission decision making. The physician will speak to the nurses on the unit, evaluate testing and monitor your condition and only then make a decision about your status. You may stay in the hospital for several days and still be on observation status.
This is important to know, because if you are not admitted, your benefits for rehabilitation at a nursing home are not available. You may still go to the nursing home, but you will have to pay privately for the care you receive. Even if you are on observation status, you may still qualify for home based therapy. Ask the discharge planner at the hospital what care you are eligible for or speak to your physician prior to discharge.
If you are not sure and aren't getting the answers you require from your healthcare professionals, please contact us for guidance.