tci Medicare Compliance & Reimbursement - 2015 Issue 20

Compliance: Watch Out for Disparity in Admission Status of Similar Patients

Learn to distinguish between observation and inpatient services. “We do not believe that observation services and inpatient services are the same services,” (78 FR 50911) states the FederalRegister. Is this true at your hospital? Are there cases in which exactly the same services are provided? How do you distinguish between the two? Here are a few examples of common scenarios and what to expect in each. Example 1: Two patients with exactly the same complaints and symptoms present to the ER. In Case A, the physician orders observation services. In Case B, a different physician decides to...

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