Observation Services

Observation services insight from the industry's top expert

Here is the essential guide for understanding observation services and the most recent regulatory guidance for inpatient admission. Author Deborah K. Hale, CCS, CCDS, uses case studies and real-life examples to examine regulatory guidelines and fiscal management, and also explains how to manage multiple payers and find an easier way to achieve reimbursement for observation services.

You will also learn about the roles of nurses and physicians in observation services and how to foster an effective team approach for compliance and appropriate reimbursement.

With your copy of Observation Services, Third Edition, you'll learn how to:

• Assign proper level of care using real-life case studies
• Implement an effective and compliant policy in accordance with the Medicare rules for observation services and instruction
• Implement a payer-specific policy in compliance with the multiple payers’ rules for observation services and instruction
• Determine improvement opportunities and understand how to use internal and external data
• Decipher  the dos and don’ts for Condition Code 44

What's new in the Third Edition?

• CMS and American Hospital Association interaction regarding observation use
• Updated guidelines on the process for use of Condition Code 44 and proper billing
• The 2011 version of ST PEPPER
• New and improved strategies for accurate billing
• New examples of provider liable claims
• New CMS instructions required for payment
• New policy and procedure examples and case studies

Topics covered include:

• Determining the right level of care          
• The consequences of incorrect level of care determination
• Correcting level of care determinations
• Condition Code 44
• Using data to determine improvement opportunities
• The role of the physician advisor
• Strategies for achieving accurate reimbursement
• The Medicare appeals process

Downloadable tools include:

• Appeal letter templates
• Level of care decision-making flowchart
• Revised PEPPER report example
• Observation pocket card reference
• UR physician documentation templates for Condition Code 44
• Transmittal 299 Condition Code 44
• MLN Matters Clarification Condition Code 44 SE0622

Here are just a few of the tools and forms you'll find in Observation Services, Third Edition.

• Appeal letter templates and sample reports
• Site of service decision-making flowchart
• Non-physician review worksheet
• Transmittal 299 Condition Code 44
• MLN Matters Clarification Condition Code 44 SE0622
• Top volume Medicare MS-DRGs

You'll receive instructions to download these and all of the forms and tools so you can use them right away!

About the Author

Deborah K. Hale, CCS, CCDS, is president and CEO of Administrative Consultant Services in Shawnee, OK.  She is the author of the first two editions of this best-selling reference and is a regular contributor to Case Management Monthly. A respected professional in the case management industry, she is a popular speaker for HCPro audio conferences and serves on the RAC Editorial Advisor Committee.

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