Corporate Compliance

Tip: Determining the appropriateness of admissions

Compliance Monitor, February 9, 2005

When a patient is admitted to your facility, it is important to be sure that the admission and procedures were appropriate to the patient's condition. Auditors can accomplish this by reviewing the patient's medical record, keeping these five questions in mind:

  • Did the patient have a condition that the facility could only treat in an inpatient setting?

  • Did the patient require treatment that the facility could only perform in an inpatient setting?

  • Were procedures necessitating admission medically necessary?

  • If not, did the patient have other conditions and treatments requiring admission?

  • Have the results been compared to any admission issues discovered by the professional review organization (PRO)?

    The above tip is an excerpt from the book "Hospital Auditing and Monitoring: Sample Programs for Key Risk Areas." Copyright 2004 by HCPro, Inc. This book is a step-by-step, practical manual that offers sample audit programs for the most troublesome areas that a hospital must audit. The binder and CD-ROM are filled with actual audit programs used by auditors and compliance officers in the field. Click here for more information or to order your copy today.

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