As hospitals transform from volume-based to value-based reimbursement, the role and functions of the utilization review (UR) committee are evolving. Learn how to refocus UR and use it as a tool for success now and in the future.
Under what circumstances would it be appropriate for a patient who does not meet inpatient criteria to be registered as outpatient receiving observation services?
This week's note clarifies the rules, regulations, and provider considerations to take into accounting following CMS' decision to remove total knee arthroplasty from the inpatient-only list.
The 2-midnight rule was designed to simplify decisions on whether to order inpatient or outpatient observation services for patients and to reduce the volume of observation cases. However, some hospitals and healthcare systems have reported that the rule has actually increased confusion around level of care, without lowering observation volumes.
This week's note provides an overview of the eligibility, scope of coverage, effective dates, premiums, and cost-sharing amount policies under the four parts of Medicare. .
We found out after an observation patient was discharged that one of the procedures performed was an inpatient-only procedure. Can we bill this to Medicare without an official inpatient order on the medical record?
