Revenue Cycle

From the field: Inpatient admission date and time compliance

Recovery Auditor Report, February 10, 2011

This past summer when the first Recovery Audit Contractor (RAC) approved the issue “inpatient admissions without a physician’s inpatient admit order,” it placed an impetus on hospitals to tighten up internal processes to avoid RAC audits and potential recoupments at their facility. Recently, CMS released guidance on hospital inpatient admission decisions, which shows that there is still confusion and room for improvement.

One seemingly prevalent hot-button issue is the date and time for an inpatient/observation admission to an acute-care facility. The admission date and time is determined by the physician’s “admit to inpatient,” order, but sometimes the correct course of action is not so cut and dry.

For example, if a physician makes the decision to “admit to inpatient” at 11 p.m. on January 1, 2011, the inpatient admission date would be 11 p.m. But if the patient is in the emergency room at this time and the order is written at 11 p.m. and the patient is not transferred until midnight, what is the proper time to document?

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