decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Hospital Model Compliance Plan / Risk areas / Submission of claims and information / Admissions and discharges
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Article Overview
This premium article explains hospital compliance risks associated with admissions, discharges, and related claim submission practices under Medicare. It is aimed at hospital billing, coding, compliance, and revenue integrity professionals who need a high-level understanding of policy areas that can affect payment and audit exposure. The discussion covers operational risk categories, CMS-related oversight, and broad considerations for avoiding improper payment practices without providing a step-by-step coding tutorial.
Why This Topic Matters
Admission and discharge status can directly affect Medicare payment and trigger compliance issues. Understanding the main risk areas helps hospitals strengthen internal controls, review claim processes, and reduce exposure to denials, overpayments, and audit findings.
What You Will Learn
- The main Medicare compliance risk areas related to hospital admissions and discharges
- How claim submission practices can intersect with hospital payment rules
- Why discharge, readmission, and transfer-related processes are important to compliance review
- How partial hospitalization and post-acute care topics fit into a hospital compliance plan
Who Should Read This
- Hospital coders
- Inpatient billing staff
- Compliance officers
- Revenue cycle professionals
- Clinical documentation staff
- Utilization review staff
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