You or your child will be receiving medical care that is best provided in our hospital on inpatient admission, outpatient extended stay, or outpatient observation services.
What does this mean for you or your child?
Many patients receiving treatment in a hospital bed with overnight stay might be designated as outpatient, while receiving either observation services or procedural short-stay services.
- Observation status: You or your child require a brief stay for testing, treatment and monitoring in a hospital bed. Published guidelines defined by the Center for Medicare and Medicaid Services (CMS) and other insurance providers give direction to your provider that require further time to determine the severity of your illness and whether you will require inpatient admission or discharge. This may affect your out-of-pocket responsibility.
- Extended recovery/Procedural short-stay status: You or your child is receiving treatment while in a hospital bed for normal recovery after an outpatient procedure that is expected to be less than 23 hours after an outpatient procedure.
What is inpatient admission?
You or your child’s condition and treatment plan meets the Center for Medicare and Medicaid Services (CMS) inpatient-only guideline. Your provider indicates admit inpatient and the treatment requires greater than two consecutive midnights.
How will the designated status impact quality of care and insurance coverage?
- Quality of Care: At Nicklaus Children’s Hospital, we work to provide the best treatment and safest care for all our patients. All necessary tests, medicine and therapies will be provided for all of the various designated types of hospital stays.
- Financial Impact: Even though you or your child is receiving treatment in a hospital bed, inpatient insurance benefits do not always apply. Thus, your out-of-pocket costs (co-pays, co-insurance, and deductibles) for outpatient services may be different from inpatient services. Please contact your insurance company for more information.
**Medicare Outpatient Observation Notice (MOON): A standardized notice developed by the Center for Medicare and Medicaid Services (CMS) to inform Medicare beneficiaries of outpatient observation status.
**Hospital Outpatient Observation Notice (HOON): A standardized notice developed by the Agency for Healthcare Administration (ACHA) to inform non-Medicare beneficiaries of outpatient observation status.
Who can I speak with if I have questions about my insurance coverage?
If you have questions, please ask the hospital staff member giving you this notice or the doctor providing your hospital care. You can also ask to speak with a representative from Patient Access, available to speak with you Monday-Friday from 8 a.m. to 4 p.m. Please call Eligibility Assistance Service 786-624-6525 or email at EAS@nicklaushealth.org.