Wiki Hospital's Mistake Means I Change POS and Coding For Services?

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carlystur

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A hospital we are affiliated with and perform ED, Observation, and Inpatient services with has placed a patient in Inpatient status too early for the service I am coding and billing for to be covered by the patient's insurance.

The patient was listed by the hospital as being in Inpatient status, but my manager is telling me to code it and POS as Emergency Department instead. I don't believe this would be correct coding or billing just so we get the service covered and paid for. Who is right here in this scenario?
 
If it was a true ED visit, before the patient was admitted to inpatient status officially, then I would be okay using the ED visit. However, if they were already admitted and considered inpatient status at the time of service, you should not bill it under ED just to get it paid. It would also have the potential to have your claim denied or flagged for audit if you billed with a different POS than the facility.
 
The hospital admitted the patient the day before our provider saw the patient. Also, in case this is important, the hospital admitted as inpatient after only 1 day of being in ED and that's the issue my manager has as CMS has the 2-midnight rule, but the hospital didn't follow it for some reason.

Editing to add the hospital portal has a Care Timeline for this patient and it states the patient was admitted on 9/1 at about 9 pm and our provider first saw the patient at about 12 pm the next day.
Screenshot 2024-09-04 125024.png
Further inspection states "Admitted (ED Boarder)" at about 8 pm on 9/1.
 
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So, if the patient is Boarded in the ED while waiting for an Inpatient bed, would that make a difference?
 
It should not matter if the patient is in the ED while waiting for an inpatient bed. You bill for status the patient was in when you saw them. Based on the info I see you should be billing as an inpatient as the patient was admitted as inpatient.
 
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