Observation services are commonly ordered and billed, but many healthcare professionals are not aware they may be doing it wrong. For Medicare patients, the Centers for Medicare & Medicaid Services (CMS) two-midnight rule states that patients in medically necessary hospitalizations should not pass the second midnight without being admitted as inpatient. That means that observation services should not even reach 48 hours. Yet patients are commonly kept in observation for three or four days, translating to up to 96 hours of observation.
This has now captured the attention of auditors who have started auditing the number of billed observation hours and are, therefore, denying claims with excess hours.
To add to the confusion, the rules for billing physician services when caring for observation patients have nuances that are not seen with any other code set and this, too, can lead to denials.
Using case examples and references, Dr. Hirsch will reinforce the basic concepts of observation billing and the complex processes necessary to avoid excess hours of observation denials. He'll clear up the confusion surrounding the compliant way to bill when a condition code 44 change is done and when observation is used and not used after surgery. And, Dr. Hirsch will review the physician observation billing rules that must be followed, giving you and your team the keys to consistently bill observation services properly and avoid denials.
Why This is Relevant:
Getting observation billing right has always been important, especially to get cost reporting right and ensure that reimbursement matches true costs and that future rate setting is based on actual historic costs. But now it is more important than ever because auditors are starting to audit for excess observation hours. Though it was previously felt to not be worth their time, auditors have caught on to the fact that many healthcare professionals are not aware they may be billing observation incorrectly.
- The patient types appropriate for observation
- How to delineate observation billing for medical and surgical patients
- How to differentiate commercial and government payer use of observation
- The nuances of professional fee billing of observation services
- How to avoid excess hours of observation denials
Who Should Attend:
Those who will benefit most from this webcast include those in utilization review, revenue cycle, revenue integrity, chief financial officers, physician advisors, case managers and billing and coding professionals.