Health Information Management

Pay-per-view: CMS proposes change to inpatient criteria

APCs Insider, July 12, 2013

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CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. Providers are worried that a Recovery Auditor will deny a short inpatient stay for lack of medical necessity and recoup payment years later. So instead, some facilities place patients in observation for longer time periods.

CMS solicited ideas for how to define an inpatient admission in the 2013 OPPS proposed and final rules because the agency was concerned about the increased length of outpatient stays in observation.

Continue reading CMS proposes change to inpatient criteria on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the July issue.



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