If the attending physician writes an admission order and later decides that the case should have been outpatient and then writes and order for outpatient, do we still need utilization review involvement and condition code 44 to change to observation?
Q: We have an off-campus provider based department that is “non-excepted,” so we have to report modifier –PN (nonexcepted service provided at an off-campus outpatient, provider-based department of a hospital). Is that for just the services that would be paid under the OPPS if the department were “excepted”?
Q: OCR has said that the comprehensive HIPAA audits will occur in 2017. We received a pre-audit letter as a CE but were not audited as part of the CE round of phase two desk audits. What is included in the comprehensive audits, and is there a chance we will be audited?
Q: We started providing allogenic hematopoietic stem cell transplants on an outpatient basis for some of our patients. Until just recently, none of them were Medicare patients, but now we have some patients that meet the physician-established criteria for the transplant being done as an outpatient. How do we include this on the claim to ensure that the cost of all components of this service are reported?
Obtaining appropriate inpatient status orders for inpatient-only procedures can be difficult due to the EMR and written orders that are still in existence. Is it true that if the surgeon or attending physician orders observation/outpatient status after an inpatient-only procedure that we must bill as outpatient? Can we use our utilization review committee to overturn the observation/outpatient order in this scenario? Please advise.
