This distinction will also play into the reimbursement that is received. CMS has now released a “Two midnight rule” meaning that you must be admitted for 2 consecutive midnights in order to be considered inpatient. Each inpatient will be placed into a Medicare severity diagnosis-related group, which will in turn affect how much the hospital will receive back. This is seen as an average of what others that fall into this group cost, and how the insurance will pay back. They will rarely pay over what others get for the same MS-DRG, even if additional services were done. Outpatient reimbursement however is done by the actual services and testing provided. Everything basically boils down to this- insurance companies want to pay back the bare minimum. All of these rules end up helping them more than they do the doctors, facilities, or patients. However, there is no way people could afford most of their healthcare without insurance, so we must follow their payment
This distinction will also play into the reimbursement that is received. CMS has now released a “Two midnight rule” meaning that you must be admitted for 2 consecutive midnights in order to be considered inpatient. Each inpatient will be placed into a Medicare severity diagnosis-related group, which will in turn affect how much the hospital will receive back. This is seen as an average of what others that fall into this group cost, and how the insurance will pay back. They will rarely pay over what others get for the same MS-DRG, even if additional services were done. Outpatient reimbursement however is done by the actual services and testing provided. Everything basically boils down to this- insurance companies want to pay back the bare minimum. All of these rules end up helping them more than they do the doctors, facilities, or patients. However, there is no way people could afford most of their healthcare without insurance, so we must follow their payment