Is your organization complying with the 2-midnight rule? Now is the time to conduct an internal audit and find out. If you don’t, a Medicare auditor may beat you to it.
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.
Observation or inpatient? It sounds like a simple question, but it continues to be a sticky area for most facilities. If your organization is having trouble correctly assigning every patient, you're not alone.
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.
A recent study indicates that more Medicare patients are being assigned to observation services than in the past, and this decision may be costing these patients money, according to the July issue of Health Affairs.
If your utilization review (UR) committee is like many others nationwide, it may not have actually met in years-and chances are your UR committee members are secretly glad that's the case. Let's face it; those meetings can be a complete snooze.
Utilization review (UR) and case management are as traditional a team as peanut butter and jelly. But some facilities are asking whether this longtime duo is really the best combination.
Determining whether a patient should be an inpatient or on observation services can be a challenging call. If the wrong decision is made or the right decision isn't properly documented, the claim will likely be denied.
