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Eleven tips to prevent errant inpatient admissions

Health Care Auditing Strategies, August 1, 2005

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A patient reports to your hospital on a Saturday afternoon with lightheadedness and nausea. Your facility admits him as an inpatient, treats him overnight for what amounts to simple dehydration, and releases him on Sunday.

That Monday, utilization review (UR) reveals that the patient's condition didn't qualify him as an inpatient. So how should your facility bill this claim? Unfortunately, you can't. By the time your facility has discharged the patient, it's too late to assign condition code 44.

Although you can make an appeal to the FI, in all likelihood your organization will have to eat the cost of the ill-advised stay. For a patient with dehydration (DRG 297), that could mean a hefty $2,000 price tag.

What's worse, this scenario happens all the time, say Arlene Baril, MS, RHIA, vice president of health information management and software services for UASI in Cincinnati, and Susan Hull, MPH, RHIA, CCS, CCS-P, manager of coding products and services for the American Health Information Management Association in Chicago.

This is an excerpt from a member only article. To read the article in its entirety, please login.

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