Hospitalized, but Not Admitted: Admission Status

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Why This is Important… • Patients strongly affected by all of this – Access to benefits – Disposition options – Disposition pressures – Changes in billing • Financial issues are large and permanent • Clinical and financial bottom lines matter – Institutions need to be healthy to help patients! • This is a general medical problem! – ~25% of all FM/GMED patients are OBS; 25% stay >48hrs – Costs hospital $33/hr per patient
Objectives • Introduction and Definitions: – Inpatient – Observation (OBS) – Interqual • Recovery Audit Contractors (RAC) and Medical Necessity (MN) • How to Navigate Observation <strong>Status</strong> in 2012
Page 1 and 2: Hospitalized, but Not Admitted: Adm
Page 3: What do these people have in common
Page 7 and 8: Medicare 101 • Medicare for Inpat
Page 9 and 10: Inpatient versus Observation • Ob
Page 11 and 12: Inpatient versus Observation: Inter
Page 13 and 14: Inpatient versus Observation: Pract
Page 15: Recovery Audit Contractors (RAC) an
Page 18 and 19: RAC Audits • UW Policy: all chart
Page 20 and 21: Medical Necessity • A test may be
Page 22 and 23: How to Navigate Observation Status
Page 24 and 25: Medicare Benefit Policy Manual, 1:1
Page 26 and 27: Examples • S: Knee pain O: Knee p
Page 28 and 29: Same patient, different documentati
Page 30: References • www.medicare.gov •

Hospitalized, but Not Admitted: Admission Status

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