Condition code 44 has been problematic for hospitals since its inception in 2004 due to CMS’ unclear language, multiple changes to the observation billing rules, and inconsistent guidance.
The rules for making proper level-of-care decisions are lengthy and confusing, which makes the role of the physician advisor within the utilization review (UR) committee extremely critical.
Care providers accept the general principle that patients have the right to direct their own care, but what if the patient refuses every discharge option you provide and wants to stay in inpatient care indefinitely?
One of the more talked-about initiatives in the Patient Protection and Affordable Care Act is the creation of accountable care organizations (ACO) and the global payment pilot projects.
