CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it comes to putting those rules into practice, things can get even more difficult.
As patient advocates, case managers often need to question physician decisions that do not follow evidence-based criteria or that go against patient wishes.
Observation services are a specific set of services provided to a patient while the physician decides whether to admit or discharge the patient. That means if a patient undergoes a procedure that requires “active monitoring,” he or she is not receiving observation services during the procedure.
Methodist South Hospital in Memphis, TN, began using the Situation, Background, Assessment, and Recommendation (SBAR) tool to meet two basic needs: standardizing communication across the facility and managing complex cases.
Families often have to make difficult decisions when a loved one is in the ICU, and they rely on hospital case managers and social workers for support and information.
There are specific MS-DRGs, called transfer DRGs, that can trigger certain transfer rules that cause a hospital to receive a reduced rate for early discharges to specific locations.
Medicare guidelines state that patients must be given a choice when it comes to their discharge options, but hospitals have a number of other options when it comes to discussing discharge plans with their patients.
