tci Medicare Compliance & Reimbursement - 2012 Issue 3

Industry Notes: $6 Million Question for Denver Hospital -- 'Observation,' 'Inpatient,' Or 'Outpatient'?

When your physician admits a patient to the hospital, your coding work isn't done -- you need to know whether the patient was admitted as an inpatient, admitted to observation care, or admitted to the ER (which qualifies as outpatient care). That differentiation cost a Denver hospital over $6 million recently. Based on a whistleblower lawsuit, the OIG investigated the admission practices of a Denver hospital, which was alleged to be inappropriately admitting patients as "inpatients" when the patients were actually in outpatient or observation status. As most coders know, inpatient reimbursement can typically be higher than outpatient or...

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