You receive a RAC demand letter for repayment. But wait a minute before you pay up—you might want to take a close look to make sure your facility was really in the wrong. Karen Sagen, managed care leader at Bellin Health System in Green Bay, WI, who has worked in revenue cycle management for the past six years, has developed a step-by-step list of things to consider before pulling out your hospital’s checkbook.
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?
