January 12 Hospital & Hospital Quality Open Door Forum Summary
Recovery Auditor Report, February 10, 2011
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Admission screening criteria
A CMS representative began the presentation portion of the call by talking about admissions screening criteria and evolution of the process over time. The representative stated that admission criteria today is based on the use of practical guidelines — a technique that sets out expectations to measure performance against specific criteria which is all linked together.
A CMS representative informed the audience of a clarification regarding comments made during the November open door forum call about combining codes from the outpatient encounter onto the inpatient claim. According to the representative, a facility that is wholly owned or operated by the hospital must include on an inpatient claim the diagnosis codes, procedure codes and charges for all outpatient diagnostic services and admission-related outpatient non-diagnostic services that are furnished to the beneficiary during the three-day payment window.
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