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What does inpatient mean in U.S. healthcare?

In this video, we’ll explain inpatient care in the simplest way possible, with real examples and why it matters in Revenue Cycle Management (RCM).

Inpatient = A patient officially admitted to a hospital with a physician’s order.
This means the patient needs continuous monitoring, specialized nursing, surgery, or treatment that requires staying in the hospital for at least one night (more than 24 hours).

Examples of inpatient care:
1. Surgery requiring recovery stay
2. Continuous monitoring for serious conditions
3. Advanced nursing care
4. Treatments not possible in short visits

Inpatient Billing in RCM:

When admitted, hospitals send an inpatient claim that usually covers the entire stay, including:
1. Room & board charges
2. Nursing services
3. Medications during stay
4. Surgeries & medical procedures
5. Diagnostic tests (X-rays, labs, scans)
6. Supplies & equipment used

Why payers review inpatient claims carefully:
Because inpatient care is more costly than outpatient, payers (insurance companies) check for medical necessity and proper documentation before reimbursing hospitals.

Quick Summary:

1. Inpatient = More than 24 hours stay with physician’s order
2. Outpatient = Same-day care, no overnight stay
3. In RCM, inpatient care uses bundled billing (all services during stay in one claim).

Who should watch this?

RCM & AR Calling trainees

Medical billing & coding students

Healthcare professionals learning U.S. system

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