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.
The federal government has been pushing hospitals to reduce the number of preventable readmissions. Now it's putting some money behind the initiative by adding two new CPT codes that will allow physicians to bill for care that may help keep patients out of the hospital.
If there's one conclusion that OCR is ready to draw from the 115 HIPAA compliance audits conducted last year, it's that there is plenty of room for improvement.
