The release of CMS' 2014 inpatient prospective payment system (IPPS) final rule was a major game changer for hospitals. While you may be caught up in understanding and applying the 2-midnight rule for inpatient admissions, it's important to remember that the final rule also brings about significant changes to quality of care. We discussed these issues and their impact on the hospital landscape during HCPro's September 10 audio conference "2014 IPPS Final Rule Explained."
It's no secret that ICD-10-CM allows for more specific coding of many diseases and conditions. However, your physician's current clinical documentation may not have enough detail to allow coders to take advantage of this increased specificity.
A case manager at a meeting described how the family of a patient was pressuring her to change the patient from outpatient services to inpatient status. If she didn't help, the family pleaded, the patient would face higher costs for postacute care. The case manager bragged about how she held the line, despite the tears. However, others in the room didn't think the details of the case were as black and white as the case manager claimed. And some wondered whether "holding the line" at any cost is really what a case manager should be doing.
Physicians and nurses tell patients how to take their medications before they leave the hospital. But many patients find these instructions confusing and may not really understand what medications they're taking, why they are taking them, or how to take them properly. The result: They take the medications incorrectly-or not at all-and end up back in the hospital.
Last month, CMM outlined the new CMS 2014 inpatient prospective payment system (IPPS) guidelines, which revised inpatient admission standards (see correction on p. 4). This month we're going to offer some tips to assist you to help physicians document accurately, and inform you about some other changes that will affect the way case managers do business when it comes to meeting the new standard.
