Patient status

Inpatient / Observation / Outpatient (Ambulatory care)

≥ two midnights

Inpatient admission

When hospital stays are two midnights or longer.

The inpatient portion may be deemed a qualified admission, even if the first day (midnight) was spent in observation status.

For inpatient admissions, the order for admission needs to state “admit to inpatient.”

Medicare Part A covers hospital inpatient services.

Medicare Part B covers most physician inpatient services.

< two midnights

Observation status OR outpatient stays

CMS treats observation status as outpatient stays. Medicare Part B covers outpatient hospital and physician services, but patients will generally have to make copayments for individual hospital services.

Levels of Care

Short Stay Acute Care Hospital (STACH)

Long Term Acute Care Hospital (LTACH)

This term refers to a hospital-grade facility for patients who are still ill enough to require a high level of complex care.

Skilled Nursing Facility (SNF)

A SNF is usually right for patients who do not need the intensive level of care offered by a LTACH but still require medical care and support before they can live on their own.

For those using Medicare, the current requirement to head to a SNF is a three-night stay in the hospital.

Inpatient Rehab Facility (IRF)

An IRF provides rehabilitative care to help patients regain functions after a severe injury or illness.

Transitional Care Unit (TCU)

Step-down medical/rehab care

Home Care

Patient Care Coordination

Is done by the care/case manager or care coordinators.

Transitions of Care

Is planned by case manager and a social worker.

Hospital Pharmacies

Inpatient Pharmacy

Inpatient pharmacy provides services to the wards, clinics, and other units in the hospital.

Outpatient Pharmacy

Outpatient pharmacy is the pharmacy which provides services to patients who do not occupy beds in hospitals.

Discharge medications must be sent to outpatient discharge pharmacy.

Hospital Billers

Manages bills and makes sure that hospital bills that are submitted to Medicare are accurate.