The Office of Inspector General (OIG) is planning to audit hospital inpatient claims for compliance with the 2-midnight rule, according to a recent update to its Work Plan.
Facing the unprecedented COVID-19 public health emergency, CMS released the 2021 OPPS proposed rule later than ever before, with the agency generally reinforcing its recent focus on site-neutral payment policies, lowering reimbursement for drugs purchased under the 340B program, and adding more services to the list of prior authorization.
Like other services covered by Medicare, observation must be reasonable and necessary or, in other words, medically necessary. The physician must document that they assessed patient risk to determine that the patient would benefit from observation services.
Q: How many hours of observation services must a patient receive before the hospital is required to provide them with the Medicare Outpatient Observation Notice (MOON)?
The nuances of documenting and billing for observation services can trip up even the savviest organization. Get a refresher on the basics to ensure your organization avoids common pitfalls.
Q: How do we bill for services when our utilization review (UR) team determines postdischarge that an inpatient admission was not medically necessary? Are these services billed as outpatient or inpatient?
Q: What is the process for submitting a claim for an inpatient hospitalization when our utilization review committee determined after discharge that the inpatient admission was not medically necessary?
