Health Information Management

Take another look at observation 

Briefings on Coding Compliance Strategies, February 1, 2009

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Revisit definitions, condition code 44, and the connection to inpatient status

A recovery audit contractor (RAC) could be knocking on your door in less than a year if the U.S. Government Accountability Office helps end the automatic stop on the program.

During the RAC demonstration project, 85% of overpayments were collected from inpatient hospital providers, according to CMS’ RAC Evaluation Report. And if these results are any indication of the future, inpatient claims will face significant scrutiny. That means providers must take care in determining the medical necessity of inpatient admissions, particularly whether inpatient status is more appropriate than observation status.

Making this determination has been an ongoing challenge for physicians, and it’s an issue that often bridges the divide—for better or worse—between inpatient and outpatient coders. In the battle against claims denials, coders are often the last line of defense.

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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