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AUDIOCONFERENCE ON TAPE OR CD

Sponsored by Observation Status: Implementing a Compliant and Effective Policy

presented on August 1, 2006

Hospitals are required to facilitate appropriate level of care orders and bill according to the physician’s intent. When it comes to determining whether or not a patient should be admitted as an inpatient, outpatient or observation patient, strict CMS guidelines are confusing at best. To further complicate matters, observation criteria and requirements vary from one private payer to the next.

Discover the strategies to handle observation status at your facility, and proactively reduce denials. This audioconference will provide strategies for making the right decisions regarding level of care, discuss new regulatory guidelines, and examine ways to receive optimal reimbursement for observation status.

At the end of this program, participants will be able to:

• Distinguish between an appropriate observation patient and an appropriate inpatient admission for both medical and surgical patients.
• Implement practical processes to facilitate appropriate "level of care" determinations.
• Identify components of an accurate outpatient claim that includes observation services. 
• Recognize Transmittal 299 and SE0622 for clarification of Condition Code 44.

AGENDA

1. Inpatient/outpatient observation status
1. Level of care determinations
2. Three different payers
   1. Commercial
   2. Medicaid
   3. Medicare
3. What does Medicare really say?


2. National focus on OIG
   1. One day stay focus on medical necessity
   2. Review of CMS “PEPPER” report
      1. How to evaluate (report) findings
   3. Guidance for process redesign to avoid after-the-fact “fixes”

3. Condition Code 44
1. Transmittal 299
2. SE0622 MedLearn Matters Clarification of Transmittal 299
3. Where does observation fit?
4. Guidance to interpret the instructions (find the answer)

4. Utilization Review Committee
1. Who should be on this committee?
2. How do case mangers facilitate that this is properly done?
3. Strategies to increase UR committee effectiveness

5. Appropriate use of observation status
1. How to report on a claim form
2. Strategies for achieving optimal reimbursement


6. Question & answer session

FACULTY

Deborah K. Hale, CCS, president of Administrative Consultant Service, LLC (ACS), is a Certified Coding Specialist with twenty five years of experience in Health Care Management including Administration, Health Information Management, Clinical Documentation Improvement, Case Management and Utilization Review. She is a member of the American Health Information Management Association and the Health Care Finance Management Association.

Faculty Disclosure: All faculty participating in continuing education provided by HCPro activities are expected to disclose to the audience any real or apparent commercial financial affiliations related to their presentations and materials.

BONUS MATERIALS

In addition to the expertise and advice presented during this audioconference, you'll also receive a slide presentation of the program materials and tools including:

• A physician pocket card
• A poster
• A physician newsletter
• An observation charge sheet

These materials will be provided with PDF links.

WHO SHOULD LISTEN?

Directors of case management, case managers, UR nurses, physicians, revenue cycle managers, HIM professionals, coders, finance.

Purchase a tape or CD of the program and listen when you can. It's a perfect training tool for new staff or as a refresher for veteran staff.

Publisher :  HCPro, Inc
 
Product Types :

• Audioconferences

Departments :

• Other Case Management Products
• Other Nursing Products

ORDER CLASS: N_08-01-2006
SOURCE CODE: EHCM