Determining whether a patient should be an inpatient or on observation services can be a challenging call. If the wrong decision is made or the right decision isn't properly documented, the claim will likely be denied.
Facilities that feel they have a strong inpatient admission screening process but still have a high observation rate may need to look closely at their data.
CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it comes to putting those rules into practice, things can get even more difficult.
Observation services are a specific set of services provided to a patient while the physician decides whether to admit or discharge the patient. That means if a patient undergoes a procedure that requires “active monitoring,” he or she is not receiving observation services during the procedure.
In 2010, HCPro’s Revenue Cycle Institute conducted its second annual in-depth study on RAC preparedness among healthcare providers. The results are now in: RAC audits have picked up, but preparation and education are still under way for many, and HIM plays an important role.
