Most physicians just want to take care of patients. But many simply don't have the basic understanding of the difference between inpatient (IP) and observation. They know how to care for patients but don't know how to transition that knowledge into a level of care. Therefore, their documentation may not reflect the acuity for an IP level of care. As a result, patients may end up staying in observation when, with proper documentation, they could have been certified as IP. This has consequences to the hospital and the patient. That is why, in many cases, documentation to accurately support the acuity of an inpatient level of care is frequently inadequate. And this leads to a multiplicity of problems emanating from that level of care decision to admission to discharge and, ultimately, potential payer denials.
There are two elements listed in Medicare regulations that must be considered in a physician judging a patient suitable for an IP level of care. These two elements, plus some practical guidelines from John Zelem, MD, FACS, will be presented during this webcast, to help improve physician document while suggesting an order for an appropriate level of care recommendation. In addition, an easy to use template will also be presented to facilitate this documentation along with documentation examples during this webcast.
Why This is Relevant:
The level of care determinations is fluid. It may change during the hospital stay. Although it has been stated that the initial order is correct 85 percent of the time from a utilization point of view, attendees will learn how to document acuity to justify that initial order. Attendees will also learn how important it is to work collaboratively with utilization review (UR) and clinical documentation integrity (CDI) to provide an accurate patient picture, resulting in compliant billing and reduction of claim denials.
- Understand the basic differences between IP and observation and how to make that decision
- Learn the essentials of utilization review (UR) and the regulations to support it
- Understand the consequences to the facility, physician, and patient for the level of care decision
- Acquire four simple guidelines that will assist in appropriate documentation for level of care recommendations
- View a template to assist in applying these guidelines along with actual examples
Who Should Attend:
Physician advisors; hospitalists; physicians; case managers; case management directors; utilization review directors, clinical documentation integrity specialists, managers and professionals; social workers; and hospital administrators.
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