Comments on: Manual changes related to condition code 44

By: Linda

Linda — Wed, 19 Aug 2009 19:01:23 +0000

If I am reading this right, the injections and infusions given during the time between the admission and the Obs order was actually written could not be charged either. Is that correct?

By: Sara

Sara — Fri, 19 Jun 2009 21:14:14 +0000

I know that there is a requirement regarding notifying the patient of the impact of the change in status in terms of financial liability for applicable deductibles and coinsurance amounts. Is a blanket statement allowable on our form or is the requirement more specific?

By: Jennifer Woolsey

Jennifer Woolsey — Thu, 18 Jun 2009 18:40:25 +0000

Barbie – see the comment that I added to address your question at the end of my comment.

By: Jennifer Woolsey

Jennifer Woolsey — Thu, 18 Jun 2009 18:39:31 +0000

Well, I would have to agree that CMS likes to keep us on our toes and confused (isn’t that their job, lol??). I know that we have changed our process for Code 44 that the observation time cannot start until the physician has agreed that the patient status can be observation and the order is written which had made some cases of not having any billable obs hours. The case managers stay on top of the new admits, but there are alot of hours that we do not have in house coverage as we do not have evening or night coverage. So, if a physician comes in the next morning on a patient that was an inpatient and changes to observation then you will not have any billable obs hours. Doesn’t CMS know that we have enough of a challenge as case managers to keep up with the regulations and try to educate MD’s, but what is it worth when CMS just tries to confuse the situation.

Barbie – it is my understanding that you bill observation hours for a pt that converts to inpatient just for the time of the observation hours. Just make sure that the patient meets inpatient status with the RAC coming.

By: BARBIE MCCATHREN

BARBIE MCCATHREN — Thu, 18 Jun 2009 16:41:16 +0000

We have alot of patients that the physician has written an order for observation, but end up being changed to inpatient status by an outside source that we have employed to help us get a handle on this situation. Can we bill for the observation hours up until the time that the new order is written for admission to inpatient or do we retro the entire episode back to inpatient status and not charge the observation charges?

By: Debbie Love

Debbie Love — Wed, 17 Jun 2009 10:50:47 +0000

What impact does this have on Physician billing?

As we continue to be confused, it is exceedingly more difficult for us to explain this clearly to the patient or POA.
Does CMS have any plans to develop clear patient education on this issue as more of us are facing RAC audits and working diligently to place patients in the correct level of care?