Inpatient vs Observation Status

• INPATIENT – when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day.
• OBSERVATION – you're an outpatient if you're getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays, or any other hospital services, and the doctor hasn't written an order to admit you to a hospital as an inpatient. In these cases, you're an outpatient even if you spend the night in the hospital.

Remember, even if you stay overnight in a regular hospital bed, you might be an outpatient. You may get a Medicare Outpatient Observation Notice (MOON) that lets you know you're an outpatient in a hospital. You must get this notice if you're getting outpatient observation services for more than 24 hours.

The MOON will tell you why you're an outpatient getting observation services, instead of an inpatient. It will also let you know how this may affect what you pay while in the hospital, and for care you get after leaving the hospital. 

What is the difference between inpatient and observation status?

Your status as a patient in the hospital is based on the level of care you need. Your status is based on our understanding of your condition. Sometimes, the conditions and care chosen for inpatient versus observation placement seem similar.

Inpatient status is when you are in the hospital and need specific kinds of care. The care you need is usually more complex or longer. An initial, formal inpatient admission status is usually because there is a care plan that routinely requires more than a day.

Observation status, is when you are placed in a bed anywhere within the hospital, but have an unclear need for longer care or your condition usually responds to less than 48 hours of care. As an observation patient, you may be admitted after the care starts, or you may be discharged home, or you may receive other care. In short, you are being observed to make sure the care is best for you – not too short or too long.

Please know that no matter what your status, your health care team will provide the care that you need.

Is my status based on how many days I stayed in the hospital?

No, your status is based on the level of care you need, not the number of eventual days that you are in the hospital. Your status is determined by your insurance company.

Can my status change while I’m in the hospital?

Yes, your status may change if your medical condition gets better or worse, or if you need more or less care. If you have any questions about your status, please ask your nurse.

Will I know if my status or my loved one’s status has changed?

Your nurse should talk to you about your status. If it’s decided that you need observation service, you may receive a letter explaining the difference between inpatient and observation status. However, in some cases, the status is not determined until after you leave the hospital.

 I was told that I was inpatient status by my nurse, but received a bill for outpatient/observation status. Is this an error?

We try to know your status during your stay, but sometimes final decisions about outpatient observation status can be made after you go home and based on your insurer’s guidelines – this means it could change after you leave the hospital. A patient’s status is always assigned based on how the hospital stay ended, not how it started.

How is a patient’s inpatient or observation status assigned?

Your final status will be assigned depending on how your hospital stay ended, not how it started. There is a chance your status may change from when you first came to the hospital. The status is based on the level of care you need. How will my status affect my insurance coverage? Depending on your insurance plan, your coverage may or may not be different for inpatient and observation status. Your insurance plan may have co-payments or deductibles for observation status that are different than if you were an inpatient. If you have questions about your co-payment, deductibles, or any other coverage questions, please call your insurance plan.