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.
A recent study indicates that more Medicare patients are being assigned to observation services than in the past, and this decision may be costing these patients money, according to the July issue of Health Affairs.
If your utilization review (UR) committee is like many others nationwide, it may not have actually met in years-and chances are your UR committee members are secretly glad that's the case. Let's face it; those meetings can be a complete snooze.
Utilization review (UR) and case management are as traditional a team as peanut butter and jelly. But some facilities are asking whether this longtime duo is really the best combination.
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.
