In a recent HCPro audio conference titled “ Observation Services v. Inpatient Admission: Assign Proper Level of Care and Prevent Denials,” experts answered listeners’ questions about proper use of observation services.
In an effort to enhance outcomes and standardize practice in pediatric patients, Children’s Hospital and Medical Center created three sets of clinical protocols for three of the hospital’s high-volume DRGs.
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.
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?
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.
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.
CMM asked hospital case management professionals what tasks their facilities expect them to perform and how those responsibilities affect their productivity in the CMM Job Responsibilities Survey. Nearly 500 case managers, discharge planners, social workers, clinical documentation improvement (CDI) specialists, and appeals specialists responded to the survey. Responses broke down as follows:
