Inpatient v. Observation Status: Leveraging Utilization Review (NL0111)
Pre-Approved for: ACM, CA BRN, CCM, CDMS, CLCP, CRC, CVRP, Delaware BON, Florida BON, RNs, RRP
Credit Hours: 6
This course discusses different methods of leveraging utilization review.
- Determine the appropriate use of OBV VS. Inpatient hospital admissions
- Identify methods to reduce unnecessary hospital admissions using a case management protocol
- Discuss methods of leveraging utilization review and case management as a RAC defense
- Explain the historical/business basis for the creation and growth of Emergency Department Observation Units
- 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
- 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?