Wiki billing observation vs outpatient

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dblack50

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We are getting RAc audits for observation. The hospital face sheet showed the patient has observation status. MCR wants us to bill outpatient. The pt came into the hospital and wa observed by our provider a few hours later the pt had surgery. Any suggestions?
 
Medicare differentiates among three types of status:
  • Outpatient
  • Inpatient
  • Observation
Here is the simplified description of the guidelines that clarify status assignments:
  • Regardless of whether the patient stays overnight, those undergoing routine surgeries are commonly classified as outpatients.
This is why Medicare wants you to bill under Outpatient status. Your patient had surgery.
  • Patients expected to be hospitalized for several days typically qualify for inpatient status.
  • Observation services are commonly ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge. An observation period can extend beyond 23 hours.
Since your patient went into the OR, a treatment decision was made. Whether or not your organization changed the status to Outpatient is unclear, but they would have to in order to get paid. This is what nurse care managers do. Collaborate with your care managers if you have questions, because the patient's status can change back and forth throughout the hospital stay. Dont' go just by the face sheets to assign codes or places of service.
 
Observation starts at the time the order was written by the physician and the time it started ended is based on the physicians order and need for continued monitoring, the place in the hospital does not matter. Observation can be begin while in the ED if the time, date and physician signature are clear. However, you can not charge for Observation at the same time as charging for another service, Surgery, Blood Transfusions etc. at the time I have some great information related to IP vs OV, but the file is too big to upload. If you are interested you can email me at nursed93@yahoo.com and I will send it. I would also check with case management and ensure the procedure performed isn't on the Inpatient only list.
 
Observation Billing

I sent you an email to your email address regarding observation billing material
 
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