Top 10 Things to Know About Patient Status

by Case Management

1. We know you didn't go to medical school and spend additional years of training to accurately determine who is an "inpatient" and who is an "observation" patient.

2. You are able to order whatever tests or treatment is needed for your patient regardless of status.

3. Status issues are relevant to reimbursement. Medicare's guidelines are strict. They are able to perform massive retro-active reviews and seek reimbursement for services already paid if they see problems. We are trying to avoid such situations like the plague!

4. Medicare no longer wants us (or you) to use the words "admit" and "status" in conjunction with observation services. They suggest the following wording:
a. "observation services for _____."
b. "provide observation services for _____."
c. "place in observation for _____."

5. Remember that observation is not necessarily a place. Although we have a "med obs" unit adjacent to the emergency department, observation patients can be found throughout the hospital (except ICU). The care of an observation patient does not differ from the care of an inpatient except the length of time it is expected to take.

We use a set of clinical criteria to determine what the patient status should be. Sometimes patients present as meeting the criteria for observation and then go on to meet criteria for inpatient status. This is the natural progression - Medicare just doesn't want us using either status as a default. Let case management help you on this - we really do want you focused on the life-saving stuff. Leave the grind to us!

6. Medicare recently announced they want to see VERY few patients moving from inpatient to observation. This should be a rare occurrence as it is not a natural progression. When an observation order occurs subsequent to an inpatient order and the observation order is clinically correct, Medicare calls this a Condition Code 44. Please call case management to discuss such a thing BEFORE you write the observation order. Also, please remember to sign, date and time any status order. If you don't, we cannot bill for the service.

7. Medicare and Medicaid will not allow us (or you) to make changes to status orders after the patient is discharged. This is why we hassle you and seem so hair-on-fire about this on the front end.

8. We bring these issues to your attention so that we can continue to provide our patients with world class care. We would hate to suffer undue financial burdens that would jeopardize our ability to serve our community.

9. Case management is happy to guide you through this maze - just call us! We have a weekend case manager dedicated to this process at extension 5431. We also have ED case managers that work seven days per week until 2 a.m. at extension 5322. Please refer to our phone list for Monday thru Friday case managers who can assist you.