Inpatient v. Observation Status: Leveraging Utilization Review (NL0111)

Course Format

This course is online. All course material is available online and is accessible immediately after purchase from your account homepage. Certificate of Completion is available immediately upon passing the exam.

Course Overview

Outline:

• Article 1: Introductory Quotes
• Article 2: Are You a Hospital Inpatient or Outpatient? If you Have Medicare – ASK!
• Article 3: Medicare Decisions: Observation or Inpatient
• Article 4: To Admit or Observe: THAT Is the Question
• Article 5: Letter FROM: American Hospital Association TO: Ms. Tavenner, the Principal Deputy Administrator of CMS – Extended Observation Services
• Article 6: Letter FROM: Federation of American Hospitals TO: Ms. Tavenner, the Principal Deputy Administrator of CMS– Extended Observation Services
• Article 7: Utilization Review Issues FAQ
• Article 8: Utilization Review and Case Management Sparks RAC Concerns
• Article 9: Emergency Nurses Association Position Statement – Observation Units/Clinical Decision Units
• Article 10:  Ed Observation Units Lower Health Care Costs
• Article 11: Clarification of Medicare Payment Policy When Inpatient Admission Is Determined Not to Be Medically Necessary, Including the Use of Condition Code 44: “Inpatient Admission Changed to Outpatient”
• Article 12: Use Condition 44 with care to avoid becoming a RAC target
• Article 13: How should the hospital report observation services when the patient’s status is changed from inpatient to outpatient using Condition Code 44?
   

Course Objectives

1. Determine the appropriate use of OBV VS. Inpatient hospital admissions


2. Identify methods to reduce unnecessary hospital admissions using a case management protocol


3. Discuss methods of leveraging utilization review and case management as a RAC defense


4. Explain the historical/business basis for the creation and growth of Emergency Department Observation Units


5. Discuss and apply Medicare rules and policy when utilization review determines that an inpatient admission is not medically necessary or when a hospital should report Condition Code 44