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?
Carolinas Hospital in Florence, South Carolina, received $431,757 in Medicare overpayments for incorrectly billed inpatient and outpatient services, according to an Office of Inspector General (OIG) audit report released November 26. Based on the sample, the OIG estimates the hospital may have received at least $3.4 million in overpayments.
