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.
Q. An insurance company is requesting copies of medical records to review our CPT coding. These cases are at least a year old and have been paid already. The insurance company said its review will not affect our payment. Do we need patient authorization to release these records, since this does not involve treatment, payment, or office operations?
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?
