Observation Status, Second Edition
A Guide to Compliant Level of Care Determinations
Deborah K. Hale, CCS
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Product Description:
Demystify observation status with the only book that explains it from case management’s perspective!
All too often, case managers have to drop everything to wade through confusing CMS and private payer regulations to determine whether a patient meets observation or inpatient criteria. And most case managers have only 24 hours to get the answer right in order to get the reimbursement they deserve.
Save time and protect your bottom line.
HCPro is proud to present the fully updated second edition of our best-selling book, Observation Status: A Guide to Compliant Level of Care Determinations. This new edition is completely revised to bring you the most current CMS regulations and MS-DRG changes.
Bonus! This book now includes a companion CD-ROM loaded with customizable tools and forms you can put to work to beat your observation status confusion today.
This new resource delivers a practical approach to understanding the convoluted world of observation status. By examining updated regulatory guidelines, management of multiple payers, the implications of OIG investigations, and strategies to prepare for Recovery Audit Contractors (RAC), this book defines a case manager’s specific role in observation status. It also explains how staff education and an effective team approach—involving nurses and physicians—can result in optimal reimbursement.
Take a look at what’s covered in the new edition:
- Fully customizable forms and tools on the accompanying CD-ROM
- Case studies that illustrate real-life challenges and solutions
- New material on collaborating with physician advisors and preparing for the RAC program
- Medicare rules for observation status and how to implement an effective and compliant policy
- Multiple payers’ rules for observation status and how to implement a payer-specific policy
- Using internal and external data to determine improvement opportunities
- Dos and don’ts for Condition Code 44
Highlights from the book include:
What is observation status, really?Determining the right level of care status
Consequences of incorrect level of care determinations
How the RAC program affects observation status
Quick and not-so-quick fixes for incorrect level of care
The role of the physician advisor
Strategies for achieving accurate reimbursement
The appeals process for denied claims
Earn continuing education credits.
ANCC—HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
This educational activity for 3 nursing contact hours is provided by HCPro, Inc.
CCMC—This activity has been approved by the Commission for Case Manager Certification for 4 continuing education units.
Your peers swear by Observation Status. Here’s what they have to say about the first edition:
“I have used the book religiously. I found it easy to read and to understand. The examples were great as well.”Tish Hart, RN, MSN,
Director ACC, Case Management & Transport Team
Central Baptist Hospital
“I liked the book because it was easy to read, fast reading, and easy to understand. The algorithms are great, especially when trying to educate staff and the physicians. Observation continues to be on the radar screen and the CMS guidelines leave too much to interpretation.”
Sharon Otten, RN, MSN,
Interim Vice President of Nursing
Advocate Trinity Hospital
Meet the author
Deborah K. Hale, CCS, president of Administrative Consultant Service, LLC (ACS), has 25 years of experience in healthcare 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 Statement: HCPro Inc. has confirmed that none of the faculty/presenters or contributors have any relevant financial relationships to disclose related to the content of this educational activity.
Who will benefit from this book?
- Case managers
- Directors of case management
- Directors of nursing
- Nurse managers
- Medical directors
- Physician advisors
Learning objectives:
- Provide a historical overview of observation status
- Identify services that are covered as observation status
- Identify services that are not covered as observation status
- Distinguish between an appropriate observation patient and an appropriate inpatient admission for both medical and surgical patients
- Determine the role of admission screening criteria in establishing medical necessity of admission
- Recognize appropriate wording for a level of care physician’s order
- Recognize the impact of incorrect level of care determinations on the hospital, physician, and patient
- Identify CMS’s strategies for measuring level of care accuracy
- Identify strategies to facilitate appropriate level of care determinations
- Overcome obstacles to effective staff education
- Identify the responsibilities of a physician advisor
- Determine methods to choose an effective physician advisor
- Evaluate internal and external data sources to measure level of care variance
- Implement improvement strategies based on data findings
- Recognize reimbursable and packaged services provided to patients in observation status
- Identify critical omissions in observation billing
- Compare a Medicare reopening with a Medicare appeal
- List the steps required to file a Medicare appeal
If for any reason Observation Status: A Guide to Compliant Level of Care Determinations, Second Edition does not meet your needs, return it within 30 days and you will receive a prompt, polite, 100% refund—no questions asked. We guarantee it!
Product Types : Departments :
SOURCE CODE: ECMW
ISBN: 978-1-60146-208-4
PUBLISHED: 09/23/2008
