Inpatient vs. Observation Status
Level of Care Compliance in a Challenging Regulatory Environment
Product Description:
Audio Conference on CD or Audio On-Demand
Sponsored by Observation Status: A Guide to Compliant Level of Care Determinations, 2nd Edition
presented on August 13, 2009
PROBLEM
Level of care determination is attracting a heightened degree of scrutiny, as Recovery Audit Contractors (RAC) and Medicare Administrative Contractors (MAC) are retroactively evaluating medical necessity of inpatient admissions and recouping overpayments that occur when the admission is determined to be unnecessary. Case management can play a major role in streamlining admission status, thereby reducing risk, and preventing denials/lost reimbursement from government auditors.
SOLUTION
Case managers can bring organization and logic to an otherwise disjointed and misunderstood process by redesigning processes and invoking a policy of collaboration on patient status decision-making. While proper use of condition code 44, which reassigns patient status from inpatient to outpatient, may help, the involvement of a case manager is a more reliable solution for achieving compliance with level of care standards.
LEARN FROM US
HCPro presents a 90-minute audio conference, Inpatient vs. Observation Status: Ensure Level of Care Compliance in a Challenging Regulatory Environment featuring Deborah K. Hale, CCS (Administrative Consultant Service). She applies a RAC focus to the problem of level of care determination, informing you of what auditors are looking for and how to remain compliant. Hale also outlines the new changes to observation status reimbursement for 2010 and present time-saving techniques and field examples to get you over your observation hurdles.
LEARNING OBJECTIVES
At the conclusion of this audio conference, you will be able to:
- Discuss easy steps for level of care decision-making
- Recognize key factors that support a medically necessary inpatient and observation status admissions
- Identify internal processes for evaluating medical necessity of admission
- Implement action steps for correcting level of care determinations
- Identify 2010 proposed changes to observation regulations and reimbursement
TAKE A LOOK AT THE AGENDA
- Permanent RAC Expansion is Underway
- What we should learn from the demonstration project about inpatient vs. observation status
- Effect of MAC review on RAC audits
- Next steps for level of care decision-making
- Beyond admission screening criteria
- Determining medical necessity of inpatient admission
- Determining medical necessity of observation status
- Determining medical necessity of outpatient procedures
- Collaboration in level of care decision-making
- The role of the ED physician
- The role of the admitting physician
- The role of the case manager
- The role of the UR committee
- The role of the physician advisor
- Changing level of care orders
- Physician order for change
- Condition code 44
- Provider liable claim
- Updates to observation reimbursement for 2010
- Rules and regulations
- Observation ambulatory payment classifications (APC)
- Question & Answer
BONUS TOOLS
With this audio conference, you'll receive a slide presentation of the program materials and several tools, including:
- Final slide presentation
- "Medicare patients: Observation or inpatient admission?" poster
- Related Medicare observation status reference newsletter
- MedLearn Matters article SE0622
- UR review document for recording advisory opinion
- Check sheet for condition code 44
- Nursing/case management acronym list for reference
MEET THE SPEAKER
Deborah K. Hale, CCS, president, Administrative Consultant Service, LLC (Shawnee, OK). Hale is a certified coding specialist with 26 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.
WHO SHOULD LISTEN?
Professionals employed by PPS and critical access acute care hospitals, as well as ambulatory surgery centers concerned with observation status. The following titles will find this program relevant:
- Director of case management
- Case manager
- UR nurse
- Physician
- Revenue cycle manager
- RAC Coordinator
- HIM professional
- Finance professional
- Coders
AUDIO ON-DEMAND
In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase a CD or audio on-demand of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.
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