Clinical Documentation Improvement Series #7. Inpatient versus Observation

in #health2 years ago (edited)

490376045 2208x628.jpg

Many procedures and treatments that used to be done in the hospital a few years ago, are done in the outpatient setting now. Because of this, when a patient is deemed “inpatient status” it becomes a target for scrutiny by the Centers for Medicare and Medicaid Services (CMS) and the private insurance companies. Sometimes, at the time of presentation it becomes difficult to make the decision between inpatient or observation status because more workup is needed and the condition needs to evolve. In general, a physician may consider a patient “inpatient status” if the hospital stay is expected to cross 2 midnight lines based on the characteristics of the case and the documentation. CMS is aware of the challenge of the decision-making and it calls it a “complex medical judgement”. The factors that should be taken into consideration when deciding if the patient will stay under inpatient status or observation status are the severity of the signs and symptoms, the medical probability of a negative outcome and the need and availability of diagnostic studies. CMS uses the Recovery Audit Contractors (RAC) in order to review the documentation of the patients’ care and to recover claim payments if they consider that cases did not meet inpatient criteria.
The difference between inpatient and observation status is critical for patients and their finances because CMS pays different rates depending on the status that is assigned1. Observation status is another way of saying "outpatient", even though the patient may remain hospitalized for several days.

Marco A. Ramos MD, CCDS

References

1. American Health Care Association/National Center for Assisted Living. “Inpatient or Observation: Knowing the Difference Could Save You Thousands.” CARECONVERSATIONS.org. https://careconversations.org/inpatient-or-observation-knowing-difference-could-save-you-thousands (accessed September 1, 2018).
In order to quote from this article please use the following:
Marco A. Ramos, “Clinical Documentation Improvement Series #7. Inpatient versus Observation,” SMO Blog (blog), September 1, 2018, https://steemit.com/health/@secondmedicalop/clinical-documentation-improvement-series-7-inpatient-versus-observation

Links to the Previous Posts in this Series

- Clinical Documentation Improvement Series #1. Documenting Acute Respiratory Failure
- Clinical Documentation Improvement Series #2. How and When Do We Use the Body Mass Index (BMI)
- Clinical Documentation Improvement Series #3. Is it Delirium or Encephalopathy?
- Clinical Documentation Improvement Series #4. Documenting Myelopathies and Radiculopathies
- Clinical Documentation Improvement Series #5. Documenting Electrolyte Imbalances.
- Clinical Documentation Improvement Series #6. Substance Dependence and Associated Conditions.

Picture purchased and downloaded from istockphoto.com under a standard license Author: Dragonimages
Sort:  

Interesting article, @secondmedicalop .
I think if u work a little more with ur post formatting and elaborate the topic a bit more, it would be perfect..!
Feel free to contact a mentor on our discord server if u feel like needing a helping hand..!

~ Christina
Engagement_Officer.png

Thanks for your honest feedback. The reason why I post like this is time. When I get home, I am ready to go to bed, and very tired. I will see if after more publications I get better.

Congratulations @secondmedicalop! You have completed the following achievement on Steemit and have been rewarded with new badge(s) :

Award for the number of posts published
Award for the number of upvotes received

Click on the badge to view your Board of Honor.
If you no longer want to receive notifications, reply to this comment with the word STOP

Do you like SteemitBoard's project? Then Vote for its witness and get one more award!

Congratulations @secondmedicalop! You have completed the following achievement on Steemit and have been rewarded with new badge(s) :

Award for the number of upvotes

Click on the badge to view your Board of Honor.
If you no longer want to receive notifications, reply to this comment with the word STOP

Do you like SteemitBoard's project? Then Vote for its witness and get one more award!

Coin Marketplace

STEEM 0.20
TRX 0.02
BTC 11141.28
ETH 386.65
SBD 1.02