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End the confusion surrounding observation status

Are you and your staff looking to gain a better understanding of observation status once and for all?

Determining whether a patient meets observation or inpatient criteria from the strict CMS guidelines can be intimidating. And to complicate matters even further, observation criteria and requirements vary from one private payer to the next.

Case managers can now get the skills, tools, and techniques they need to end the observation status confusion. Observation Status: A Guide to Compliant Site of Service Designations is a practical approach to understanding the convoluted world of observation status. By defining a case manager's specific role in observation status, this book examines new regulatory guidelines, management of multiple payers, and fiscal management. It also explains how an effective team approach—involving nurses and physicians—can result in optimal reimbursement.

Observation Status will help you:

• define a case manager's role in determining the right level of care status
• adhere to multiple payers' rules for observation status and how to implement a payer-specific policy
• comply with Medicare rules for observation status and learn how to implement a compliant and effective policy
• clarify the mystery of Condition 44 and learn how to decode it
• apply internal and external data to determine improvement opportunities
• watch for future policy changes, trends, and expectations

TABLE OF CONTENTS

• Chapter 1: What is observation status, really?
• Chapter 2: Determining the right "level of care" status
• Chapter 3: Consequences of incorrect "site of service" determinations
• Chapter 4: Using data to determine improvement opportunities
• Chapter 5: Quick and not so quick fixes for incorrect "site of service"
• Chapter 6: Strategies for achieving accurate reimbursement
• Appendix
  • ICD-9-CM codes qualifying for seperate observation payment
  • Inpatient Only List 2006
  • Site of Service Decision Making Flow Chart and Text
  • Rhode Island Hospital (OIG)
  • Utilization Review Committe (Medicare Conditions of Participation)
  • Primaris Non-Physician Review worksheet
  • Transmittal 299 Condition Code 44
  • MLN Matters Clarification Condition Code 44 SE0622
  • ABN

WHO NEEDS THIS BOOK

Observation Status: A Guide to Compliant Site of Service Designations is a valuable, must-have resource for

• case managers
• directors of case management
• directors of nursing
• nurse managers
• medical directors
• physician advisors

ABOUT THE AUTHOR

Deborah K. Hale, CCS, president of Administrative Consultant Service, LLC (ACS), has 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: Deborah K. Hale has declared that she has no commercial/financial vested interest in this activity.

Accreditation Statement

HCPro is accredited as a provider of continuing education by the American Nurses Credentialing Center Commission on Accreditation.

Credit Designation Statement

This educational activity for 3 nursing contact hours is provided by HCPro, Inc.

This publication has been approved by the Commission for Case Manager Certification for 4 continuing education credits.

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