tci Medicare Compliance & Reimbursement - 2015 Issue 20

Federal Register on Condition Code 44

“As we stated for the Condition Code 44 policy (MCPM, Chapter 1, Section 50.3.1), changes in patient status from inpatient to outpatient should be few because hospitals should have case management and other staff available at all times to assist the physician in making the appropriate initial admission decision. Use of Condition Code 44 or Part B inpatient billing pursuant to hospital self-audit is not intended to serve as a substitute for adequate staffing of utilization management personnel or for continued education of physicians and hospital staff about each hospital’s existing policies and admission protocols...

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