As we await more instructions from CMS on implementation of the OPPS and MPFS final rule, I thought I would take this time to let those who missed the CMS notice know that they will be hosting another National Provider Call on Tuesday, January 14th from 1:30 to 3:00 p.m. EST.Click the link above for more information and an in-depth analysis.
Last month, CMM outlined the new CMS 2014 inpatient prospective payment system (IPPS) guidelines, which revised inpatient admission standards (see correction on p. 4). This month we're going to offer some tips to assist you to help physicians document accurately, and inform you about some other changes that will affect the way case managers do business when it comes to meeting the new standard.
Observation or inpatient? It sounds like a simple question, but it continues to be a sticky area for most facilities. If your organization is having trouble correctly assigning every patient, you're not alone.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. Providers are worried that a Recovery Auditor will deny a short inpatient stay for lack of medical necessity and recoup payment years later. So instead, some facilities place patients in observation for longer time periods.
It is an ongoing challenge for case managers to determine whether a patient is more appropriately placed as an inpatient or in observation. Below are some real-life examples provided by Deborah Hale, CCS, CCDS, in the HCPro book Observation Services: A Guide to Compliant Level of Care Determinations.
