Q&A: Inpatient-Only Procedures on Outpatients

September 6, 2016
Medicare Web

Q: Is there any reason why an inpatient-only procedure would be performed on an outpatient?

A: Inpatient-only procedures are sometimes performed inadvertently on outpatients, and this can happen for several reasons. First, staff involved at each level, including clinical, financial, and administrative, may not be aware that patients must be admitted as inpatients before certain procedures are performed. Educating staff can be a complex process that begins at the point of surgery scheduling and registration, and carries through to denial of payment. Creating a hospital policy that promotes communication will encourage consistency in training and rapid identification of an inpatient-only procedure during various points of care.

Second, inpatient-only procedures may not always be planned. This may occur during an outpatient surgery if the surgeon discovers something unexpected that must be addressed and converts to a different, inpatient-only procedure. This situation may also occur if the patient’s condition becomes unstable during the surgery and an inpatient-only procedure must be performed to stabilize the patient.

The bottom line of performing inpatient-only procedures on outpatients is that it can impact the hospital’s revenue stream. Remember that not only will the inpatient-only procedure be denied, but all other services on the same claim will also be denied, and the hospital will receive no payment.

For more information, refer to the Inpatient-Only Procedures Training Handbook.

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