CMS Pub Defines Inpatient vs. Outpatient

Misrepresenting a person as an inpatient or outpatient can be a costly mistake, even when unintentional. Differentiating the sometimes fine line between the two types of hospital status, however, can be confusing. To clarify matters, the Centers for Medicare & Medicaid Services (CMS) recently published an electronic document detailing the criteria Medicare uses to determine whether someone is an inpatient or outpatient.

Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask! is marketed toward consumers, but anyone working in health care would do well to pocket this handy reference.

Certified Inpatient Coder CIC

Here’s an excerpt:

“An inpatient admission begins the day you’re formally admitted to the hospital with a doctor’s order. The day before you’re discharged is your last inpatient day. You’re an outpatient if you’re getting emergency department services, observation services, lab tests, or X-rays, and the doctor hasn’t written an order to admit you as an inpatient even if you spend the night at the hospital.”

Included is a medical chart detailing common situations and how Medicare Part A and/or Part B would pay.

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