The rule is very easy to state: To qualify for Medicare nursing home coverage a patient must have first been a hospital inpatient for a minimum of three consecutive days. The rule is complicated by the fact that annually more than a million and a half Medicare beneficiaries are physically in a hospital overnight but have not been formally admitted and thus are not inpatients.
Inpatient or Observational
The most common example begins when a person arrives at the emergency room of a hospital. Initially he or she is an outpatient. A medical decision must then be made whether to treat and send the person home or to admit the person as an inpatient. This is called “observation status,” and surprisingly the process can take days. During those days the care given to the observation status patient is indistinguishable from the care given to an inpatient. The observation status patient is in a bed in a hospital room, receiving tests and procedures and tended to by physicians and nurses.
