Medicare Compliance & Reimbursement - 2018 Issue 2
You Be the Coder: Know What Constitutes An 'Inducement"
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Article Overview
This premium article explains why billing decisions between inpatient admission and lower-acuity hospital services are receiving increased scrutiny. It is aimed at coding, compliance, and hospital revenue cycle professionals who need to understand the broader regulatory and audit context, including a reported settlement, concerns about medically unnecessary admissions, and the role of internal compliance reporting. The discussion is informational and focuses on the compliance environment rather than detailed coding mechanics.
Why This Topic Matters
Admission status affects both payment and compliance risk, so understanding the audit and inducement concerns helps hospitals and physician groups reduce exposure to billing and medical necessity problems.
What You Will Learn
- Why admission-versus-observation decisions are drawing increased scrutiny
- How compliance concerns can arise in the hospital admission process
- What kinds of organizational responses are expected when potential infractions are identified
- How a reported settlement illustrates the broader regulatory environment
Who Should Read This
- Medical coders
- Compliance officers
- Hospital revenue cycle staff
- Physicians
- Emergency department administrators
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