Part B Insider - 2019 Issue 9
Reader Question: Are Admits Being Tracked?
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Article Overview
This article explains why hospital leaders may review emergency department-to-inpatient admission patterns and places the issue in the context of federal oversight activity reported by the HHS Office of Inspector General. It is aimed at hospital compliance staff, coders, auditors, and administrators who need a high-level understanding of fraud risk, self-audit considerations, and the broader compliance environment surrounding hospital admissions.
Why This Topic Matters
Admission patterns can attract internal review and external scrutiny when they appear inconsistent with medical necessity expectations. Understanding the compliance and audit context helps hospitals reduce risk and evaluate their own admission practices responsibly.
What You Will Learn
- Why emergency department admissions may draw administrative or compliance attention
- How federal oversight reports frame admission-related fraud concerns
- Why hospitals may perform self-audits of admission patterns
- What types of compliance and enforcement issues can arise in this context
Who Should Read This
- Hospital administrators
- Compliance officers
- Medical coders
- Auditors
- Revenue integrity staff
- Emergency department leadership
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