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Tip: Review one-day stays for medical necessity

Case Management Weekly, October 13, 2010

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One-day stays are common problem areas that are easy for recovery audit contractors (RAC) to target. One-day stays raise suspicion because the patient did not remain overnight; however, this alone does not disqualify the case from being an inpatient case.

The case is an appropriate inpatient admission if the expectation that the patient remain overnight was reasonable at the time the inpatient order was written, but the patient unexpectedly improved and was discharged. This situation should be relatively infrequent, and the utilization review (UR) committee should consider reviewing all one-day stays for medical necessity. It should determine whether the patient’s condition at the time of the inpatient order warranted inpatient care, even though the patient later improved. The review should not take into account test results and developments in the patient’s condition not known at the time of admission. Consider only what the attending physician knew when the order was written.

This week’s question and answer is adapted from The RAC Survival Guide: Successful Management of Recovery Audit Contractors, published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.

Do you have a question about a case management topic? Send it to Associate Editor Ben Amirault at bamirault@hcpro.com. An answer to your question might appear in a future issue of Case Management Weekly.

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