tci ED Coding & Reimbursement Alert - 2018 Issue 2

You Be the Coder: Know What Constitutes An 'Inducement"

Question: We keep hearing that we should be more careful about which cases to bill as observation and which are admissions. This is a difficult call for the doctors. Why all the recent scrutiny? Supercoder.com Subscriber Answer: Government and private insurance auditors are becoming ever more interested in the rising costs of hospital admissions, particularly when less expensive options (such as outpatient or observation care services) are medically indicated. In fact, just last month, a Texas-based firm that provides physicians to hospitals to staff their EDs agreed to pay almost $30 million to resolve claims suggesting that the...

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