1.An admission note documents the reasons why the patient has been admitted for inpatient care to a hospital or other facility. 2. Medical treatments and surgeries have been categorized into inpatient and outpatient procedures. 3. If you have been referred to hospital for an operation or test and you need to stay overnight, it means you're being treated as an inpatient. 4. Since April 2011 a monthly report of the number of times they breach the Department of Health's same-sex accommodation guidance has been had to provide by the hospitals. 5. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. 6. All the patient samples from the hospital and from doctors' surgeries had been sent to the pathology department for testing by 11 a.m. yesterday. 7. Patients had to stay at the medical facility where their procedure had been done for at least one night. 8. Thanks to advances in medical techniques and technology, many treatments will have been done as outpatient care by the beginning of the year. 9. You will have been visited by the hospital chaplain by the evening.
Listening
33. Watch the video ‘Patient Admission to Discharge’ and answer the questions:
https://www.youtube.com/watch?v=XhzKD5HmMT4
ü What paper is a patient given upon admission?
ü What does a chaplaincy do for the patient’s spiritual support?
ü What information is given on the white board in patient’s room?
ü What members of the team visit the patient during the day?
ü What is the best way to prevent infections?
ü What is an identification bracket?
ü Why does the patient need a call button?
ü What is Code Help?
ü How can the pain be controlled?
ü How many meals does a patient have a day?
ü Is there an access to the free Wi-Fi in the hospital?
ü How the staff of the hospital help to consider leaving the hospital?
Vocabulary
34. Fill in the chart below:
HOSPITAL
Types
Staff
Departments
35. Describe the ‘inpatient rout’ to the hospital according to the chart beow:
The traditional, rational definition of being admitted usually involves spending an overnight in the hospital. This definition is sometimes stretched in the U.S. medical billing industry, where hospital corporations may blur the definitions of "admission" and "observation" because of reimbursement rules under which healthcare payers pay less for the care if an "admission" was involved. Inpatient care tends to be directed towards more serious ailments and trauma that require one or more days of overnight stay at a hospital. For the purposes of healthcare coverage, health insurance plans require you to be formally admitted to a hospital for a stay for a service to be considered inpatient. This means a doctor has to write a note to give the order to admit you, so if you were in the emergency room and were asked to stay overnight for “Medical Observation”, it does not make you an inpatient. Over half of all inpatient hospital admissions come through the emergency room department. Medical observation is a medical service aimed at continued care of selected patients, usually for a period of 6 to 24 (sometimes more) hours, to determine their need for inpatient admission. This service is usually provided in emergency departments. A patient held for observation is not admitted to the hospital, though there are certain similarities: patients will be checked in, pertinent information from the patient or their representative can be taken, and nurse(s) and doctor(s) from the given department may visit and a physical exam and personal and family history, and basic blood and imaging tests be conducted, and a bracelet for the observation period be given to the patient. However, they are not admitted formally to the hospital, they are not assigned a bed on the hospital's patient floors outside of the ER or the department they arrived in, and they are not assigned an attending provider or to a group of nurses and aides.In the United States, some Medicare patients have spent several days at the hospital, but never officially being in the hospital, which results in unexpected bills and makes them ineligible for Medicare payment for some future necessary services, especially skilled nursing care.
https://www.youtube.com/watch?v=lv2BAcLhwKc Children hospital, Surgery
https://www.youtube.com/watch?v=mygmoUzjrB4 emergency department
Inpatient care is broken into two parts: the facility fee and those related to the surgeon/physician. Generally speaking, copays for inpatient services are structured either on a per stay or per day basis for the facility. For some plans, copays are often a few hundred dollars per admission and up to as much as $1,000. In a few cases, cost sharing including both a multi-hundred dollar copay and coinsurance on top of it.
If you have Medicare, you should ask whether or not you are considered inpatient or outpatient. Your hospital status (whether the hospital considers you an “inpatient” or “outpatient”) affects how much you pay for hospital services (like X-rays, drugs, and lab tests) and may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay.
You’re an inpatient starting when you’re formally admitted to a hospital with a doctor’s order. The day before you’re discharged is your last inpatient day.
You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital.
The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need 2 or more midnights of medically necessary hospital care, but your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.
Medicare: What You Pay as an Inpatient
What do you pay as an inpatient?
Medicare Part A (Hospital Insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in a hospital.
Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20 percent of the Medicare-approved amount for doctor services after paying the Part B deductible.
Health insurance is insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.
According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. It includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment"
A health insurance policy is:
1. A contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g. annually, monthly) or lifelong in the case of private insurance, or be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance.
2. (US specific) Provided by an employer-sponsored self-funded ERISA plan. The company generally advertises that they have one of the big insurance companies. However, in an ERISA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore, ERISA plans are not subject to state laws. ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor (USDOL). The specific benefits or coverage details are found in the Summary Plan Description (SPD). An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary's decision can be brought to the USDOL to review for ERISA compliance, and then file a lawsuit in federal court.
The individual insured person's obligations may take several forms:
· Premium: The amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage.
· Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Furthermore, most policies do not apply co-pays for doctor's visits or prescriptions against your deductible.
· Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.
· Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
· Exclusions: Not all services are covered. Billed items like use-and-throw, taxes, etc. are excluded from admissible claim. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.
· Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
· Out-of-pocket maxima: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maxima can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
· Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
· In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
· Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.[3]
· Explanation of Benefits: A document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined.
Prescription drug plans are a form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. Such plans are routinely part of national health insurance programs. For example, in the province of Quebec, Canada, prescription drug insurance is universally required as part of the public health insurance plan, but may be purchased and administered either through private or group plans, or through the public plan.[
Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.
