Like other services covered by Medicare, observation must be reasonable and necessary or, in other words, medically necessary. The physician must document that they assessed patient risk to determine that the patient would benefit from observation services.
The nuances of documenting and billing for observation services can trip up even the savviest organization. Get a refresher on the basics to ensure your organization avoids common pitfalls.
Q: How do we bill for services when our utilization review (UR) team determines postdischarge that an inpatient admission was not medically necessary? Are these services billed as outpatient or inpatient?
Q: What is the process for submitting a claim for an inpatient hospitalization when our utilization review committee determined after discharge that the inpatient admission was not medically necessary?
