Case Management

Q&A: Backdating an inpatient admission

Case Management Weekly, February 23, 2011

Q: A patient receives observation services following an emergency department (ED) stay, but the physician decides he should have admitted the patient as an inpatient. May a physician write an order that states “admit patient to inpatient status, at the time the patient left the ED”? If so, may the hospital bill for inpatient admission time beginning at the time the patient left the ED?

A: When a physician initially orders outpatient observation services and then subsequently changes the order to inpatient admission, the hospital must bill for inpatient care starting at the date and time the order was changed to inpatient admission. The hospital may not roll the date and time of inpatient admission back to the time the patient was initially ordered to receive outpatient observation services. The case management or utilization review department must notify the billing office to ensure that the “from” and “through” date(s) on the claim reflect the date and time the order was changed to inpatient admission.   

Deborah K. Hale, CCS, CCDS, President and CEO of Administrative Consultant Service, LLC, answered this reader question.

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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