Health Information Management

Tip of the Week: Understand entry points for observation admission

APCs Insider, October 12, 2007

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In order to ensure complete observation documentation, your facility should think about the entry points through which an observation patient enters the hospital system. This allows staff members to track and document patient information and capture appropriate billable charges.

The following are several typical entry points:

  • Direct admission from a physician's office: Under this scenario, a physician sees the patient in his or her office, and orders the patient to go directly to the hospital to receive diagnostic tests and medical monitoring.
  • Admission from the ED: Often an ED physician doesn't have admitting privileges. The ED physician determines whether the patient is clinically unstable to go home and calls on an attending physician or primary care physician to report the status of the patient. The attending or primary care physician could then order the patient to be admitted as an observation patient to the hospital. Valerie Rinkle, MPA, revenue cycle director for Asante Health System in Medford, OR, noted that this situation can be tricky, because at this stage, the physician is likely concerned about getting the patient into a hospital bed and not the patient's status.
  • Admission from a postsurgical or postprocedure case: This scenario occurs postprocedurally, and is in no way anticipated preprocedurally.
  • Admission from a large, hospital-based clinic practice: In this scenario, certain departments of a hospital operate as primary care clinics or specialty care clinics. The physician evaluates the patient and determines whether the patient should be admitted for observation. This would not be considered a direct admit because the clinic, which is part of the hospital, would bill for the visit.

(The above tip appeared in the November 2007 issue of Briefings on APCs).

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