Inpatient Facility Coding & Compliance Alert

Question: How do you prove medical necessity in LTCHs and prevent the vicious cycle of overpayments and recovery by Medicare?

Texas Subscriber

Answer: Documentation should ideally start prior to admission and continue all through the patient’s stay. Federal law requires validation of medical necessity based on the documentation at least within 48 hours of admission. In addition to this, there must be documentation of continued stay review throughout the patient stay. There should be active physician involvement with patients during treatment. All services of the team should be directed by the physician.