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Your questions: expert answers

Case Management Weekly, October 30, 2007

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In this issue of Case Management Weekly, we're offering you a quick insight from Deborah K. Hale, CCS, on determining inpatient status. Hale was answering questions from case managers during the recent audioconference, Inpatient vs. Observation Status: Managing levels of care to ensure compliance and reimbursement.

"The instruction for billing the patient when an inpatient-only procedure is performed in the outpatient setting is taken from the Federal Register final rules for OPPS, April 7, 2000.

"Inpatient-only procedures performed in the outpatient setting are statutorily excluded from payment; therefore, they are billable to the patient without an Advanced Beneficiary Notice.

"Commentators on the OPPS rules have requested the list be eliminated, because the physician is paid by CMS, even if the procedure is performed as an outpatient. Yet CMS is unwilling to make any changes at this time, stating that it is the hospital's responsibility to ensure the appropriate level of care is ordered."

Source: You can read the full Q&A section in the November issue of Case Management Monthly or listen again to the full audioconference at the HCMarketplace.

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