Revenue Cycle

Inpatient admissions decision fuels RAC uncertainty

Recovery Auditor Report, August 5, 2010

Recent approval of a Region C RAC issue for inpatient hospital claims review has initiated uncertainty, thus putting an emphasized onus on providers to lean on CMS guidance and policy manuals.

The issue, “inpatient admissions without a physician’s inpatient admit order,” can be referenced in the Medicare Claims Processing Manual, Section 50.3 where it states that “patients are admitted to the hospital as inpatients only on the recommendation of a physician or licensed practitioner permitted by the State to admit patients to a hospital.” While the posting of this issue may have come as a bit of surprise, it has always been one of the basic premises of accurate billing, according to Deborah Hale, CCS, CCDS, president and CEO of Administrative Consulting Service, LLC in Shawnee, OK.

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