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CMS says MOON errors will not affect billing/payment. EDITORS NOTE: This article is an update from last week's article Erroneous Guidance by NGS Could Pose Problems for Hospitals. Observation hours will not be removed from claims if hospitals fail to accurately complete and deliver to patients the Medicare Outpatient Observation…
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Protecting patient rights is one of the cornerstones of Medicare policy. As a doctor, I can assure you that I would rather patients concentrate on their health and not worry about whether their medical providers or their insurers are making decisions for them based on considerations that are not in…
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Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2, 2019. In the post, Verma asserted that CMS would require Recovery Audit Contractors (RACs) to “maintain a 95 percent accuracy…
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Assigning status to likely terminal patients. I received a great question last week and thought I’d share it with you, our readers. This case management manager wanted to know how to determine status for a patient who came into the ED and was deemed unlikely to live past 24 hours.…
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Multiple visits to observation patients may soon be payable but…  When one looks at the current payment structure for observation medicine from the physician viewpoint, it makes no sense. Although observation patients are not as sick as inpatients, the amount of time and number of daily visits needed to care…
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Better ED quality measures, and, ultimately, greater patient satisfaction are among benefits cited. The placement of registered nurse (RN) case managers in the emergency department, with a focus on determining appropriate admission status and making status recommendations to admitting physicians, has proven to be very successful at Waukesha Memorial Hospital…
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Observation is a service, not a status. As we have all seen in recent events on television, choice of words matters. That’s particularly true in the utilization review world. And one word that matters an awful lot is “observation.” I am sure you have all heard this a million times…