Wiki Inpatient to Observation status AFTER discharge.

[Kaidachi]

I'm coding/billing for Facility and having an ongoing discussion about whether they can retroactively change a patient stay from inpatient to observation after the patient is discharged once they received a denial from a payor after utilization review.
Does anyone know if some payors allow this?
I know that CMS guidelines specifically state that you can change the patient status from Inpatient to Observation BEFORE discharge, before sending the claim and if the provider agrees it should be changed.
However, no matter how much I tell them this they still believe they should be able to change it as they usually don't get the determination from the payor until after the patient is discharged.
I've found a few where they are attempting to update the stay to observation maybe 10+ days after the patient is gone.

Can anyone either confirm my understanding or theirs?
Please provide sources for your rationale either way.
I'm at my wits end!!
-Thanks

 

[Pam Warren]

Yes, they can, and actually, it was probably the payer that insisted on the change. Based on clinical indicators (and other factors), payers determine what level of care they will cover by discussing with case managers at your hospital. Even after discharge. Unless your hospital's contract with that payer states otherwise (which I strongly doubt), you'll be paid based on the level of care that is ultimately decided, even if it's after the patient left the building. You can attempt to fight it (usually hospitals employ physicians and experienced nurses to argue this), and there are third party groups that also can participate, but it's standard practice, unfortunately.

 

[Kaidachi]

So only Medicare requires the patient to be notified before they leave? I can't find anything online that tells me that other payers don't also require this.
Can you send me some sources for this being the case?