Observation or inpatient? It sounds like a simple question, but it continues to be a sticky area for most facilities. If your organization is having trouble correctly assigning every patient, you're not alone.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. Providers are worried that a Recovery Auditor will deny a short inpatient stay for lack of medical necessity and recoup payment years later. So instead, some facilities place patients in observation for longer time periods.
It is an ongoing challenge for case managers to determine whether a patient is more appropriately placed as an inpatient or in observation. Below are some real-life examples provided by Deborah Hale, CCS, CCDS, in the HCPro book Observation Services: A Guide to Compliant Level of Care Determinations.
A recent study indicates that more Medicare patients are being assigned to observation services than in the past, and this decision may be costing these patients money, according to the July issue of Health Affairs.
