E/M Coding Alert - 2018 Issue 4
Reader Question: Know How to Answer the SNF Question
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Article Overview
This reader Q&A addresses a common Medicare coverage misunderstanding involving emergency department care, observation services, and skilled nursing facility concerns. It is aimed at clinicians, coders, and billing staff who need a clear, nontechnical explanation for patients about hospital status, beneficiary notices, and related post-discharge options. The discussion also references the Medicare Outpatient Observation Notice and the role of hospitals and critical access hospitals in notifying beneficiaries.
Why This Topic Matters
Patients often assume that time spent in the emergency department or observation automatically counts toward later post-acute coverage. Understanding the difference between outpatient and inpatient status helps staff communicate accurately, support proper beneficiary notification, and set expectations about post-discharge resources.
What You Will Learn
- How Medicare distinguishes outpatient observation from inpatient hospital status
- Why patient expectations about post-acute coverage can differ from coverage rules
- What the Medicare Outpatient Observation Notice is used for
- What general types of follow-up support may be discussed after observation care
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle staff
- Clinicians
- Hospital case management staff
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