Health Information Management

One-day stays

Briefings on Coding Compliance Strategies, November 1, 2008

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Forty percent of Medicare admission denials relate to improper one-day stays. If this statistic doesn’t catch your attention, it should, said Judi McCabe, RN, MSHP, CPHQ, former director of the Hospital Payment Monitoring Program at TMF Health Quality Institute in Austin, TX, during HCPro’s July 15 audio conference, “One-Day Stays: Ensure Compliance and Prevent RAC Recoupments.” Take into account two- and three-day stays, and the number of denials nearly doubles.

But that’s not all. In June, Medicare released the results of its three-year Recovery Audit Contractor (RAC) pilot program. Since the program’s inception in 2006, RACs have recouped almost $1 billion in overpayments, 85% of which came from inpatient hospitals.

By January 2010, the RAC program will roll out nationwide. One-day stays will likely take center stage, not only as a target for RAC reviewers, but also as cause for audits by the Office of Inspector General and CMS, Dennis Perry, MD, medical director of the Department of Case Management and Utilization Review at Ingham Regional Medical Center in Lansing, MI, said during the audio conference.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on Coding Compliance Strategies.

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