NEWS YOU CAN USE: Once an Inpatient, Not Always an Inpatient
Here's what to do when your patient changes status
Know your patient's whereabouts with new condition code
Here's the deal: The physician admits a 71-year-old woman to an inpatient bed. But later the hospital utilization committee reviews the case and decides that the patient's care hasn't met the facility's requirements for inpatient admission. Should you bill the services as inpatient?
No, according to a recent CMS transmittal - bill the services as outpatient. The agency has come up with a new condition code to describe this sticky situation: 44 (Inpatient admission changed to outpatient). You'll report this code on outpatient claims with bill types 13x or 85x.
The catch: Make sure your services meet the following conditions if you decide to report condition code 44:
You make the change to outpatient status before discharge or release - while the patient is still receiving hospital services
You haven't already submitted a claim for inpatient admission
A doctor agrees with the utilization review committee's decision
You've documented the physician's agreement in the patient's medical record.
Once the situation meets these criteria, you should treat the episode of care as if it were outpatient the entire time, CMS says. Make sure you use qualifier BG on claims with condition code 44.
New technical manual cuts your guesswork on quality standards
CMS and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) took another step Sept. 15 to streamline your reporting responsibilities - and help patients make "apples-to-apples comparisons" between facilities.
The organizations have issued a technical manual, which is a single comprehensive set of quality measures that all stakeholders can use. It provides common definitions for each of the measures that are being collected and reported. Beginning with discharges in January 2005, the common definitions will be used for both the national voluntary hospital reporting initiative and for JCAHO accreditation. Common schedules for future modifications are also in the works.
Participating hospitals now report data on heart attack, heart failure and pneumonia. However, the technical differences between how CMS and the JCAHO specified the quality measures increased hospitals' data collection and reporting burdens on hospitals, according to CMS Administrator Mark McClellan.
To read the new technical manual, go to
http://www.cms.hhs.gov/quality/hospital.
Don't let reimbursement become restitution
Want to keep operating costs from multiplying down the road? Make sure non-allowable charges don't sneak their way into your Medicare claims.
A Downey, Calif., hospital will pay Medicare twice its expenses - more than $2.2 million - to resolve false-claims allegations brought by one of its physicians. Ronald Crowell, the [...]
- Published on 2004-10-11
