Case Management

Sneak peek: Investigate gray areas to improve patient status assignment

Case Management Weekly, May 25, 2011

Not every patient status decision is difficult. Some are quite obvious.

"I don't think a hospital has ever received a request for a medical necessity review of a patient in the ICU intubated on a dopamine drip," said Ralph Wuebker, MD, MBA, vice president of audit, compliance, and education for Executive Health Resources, during the April 5 HCPro, Inc., audio conference, "Short Stays: A Data-­Driven Approach to Medical Necessity."

But Recovery Audit Contractors and Medicare Administrative Contractors (MAC) are not concerned with simple patient status decisions. They focus on the cases that fall into the gray area of patient status.

Facilities that do not have a strong Medicare admission review process will struggle to get these cases correct and defend them should they come under scrutiny, Wuebker said.

Check out the June 2011 Case Management Monthly to learn more. You also can discover the benefits of becoming a Case Management Monthly subscriber.

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