Observation Status: A Guide to Compliant Site of Service Designations

Softbound Book + bonus CD-ROM
Size: 8.5" x 11" book
Includes 3 Nursing Contact Hours!
ISBN 1601462085
978-1601462084
HCPro
October 2008
(click button below for the very best currently available price for this guidebook)

Earn 3 Nursing Contact Hours!

Observation Status: A Guide to Compliant Site of Service Designations is a practical approach to understanding the convoluted world of observation status. By defining a case manager's specific role in observation status, this book examines new regulatory guidelines, management of multiple payers, and fiscal management. It also explains how an effective team approach, involving nurses and physicians, can result in optimal reimbursement.

This new resource delivers a practical approach to understanding the convoluted world of observation status. By examining updated regulatory guidelines, management of multiple payers, the implications of OIG investigations, and strategies to prepare for Recovery Audit Contractors (RAC), this book defines a case manager’s specific role in observation status. It also explains how staff education and an effective team approach—involving nurses and physicians—can result in optimal reimbursement.

Are you and your staff looking to gain a better understanding of observation status once and for all? Determining whether a patient meets observation or inpatient criteria from the strict CMS guidelines can be intimidating. And to complicate matters even further, observation criteria and requirements vary from one private payer to the next. Take a look at what’s covered in the newest edition:

Fully customizable forms and tools on the accompanying CD-ROM
Case studies that illustrate real-life challenges and solutions
New material on collaborating with physician advisors and preparing for the RAC program
Medicare rules for observation status and how to implement an effective and compliant policy
Multiple payers’ rules for observation status and how to implement a payer-specific policy
Using internal and external data to determine improvement opportunities
Dos and don’ts for Condition Code 44

End the confusion surrounding observation status. With this resource, case managers can now get the skills, tools, and techniques they need to end the observation status confusion. Observation Status will help you:

define a case manager's role in determining the right level of care status
adhere to multiple payers' rules for observation status and how to implement a payer-specific policy
comply with Medicare rules for observation status and learn how to implement a compliant and effective policy
clarify the mystery of Condition 44 and learn how to decode it
apply internal and external data to determine improvement opportunities
watch for future policy changes, trends, and expectations

This book covers these topics fully:

What is observation status, really?
Determining the right "level of care" status
Consequences of incorrect "site of service" determinations
How the RAC program affects observation status
Quick and not-so-quick fixes for incorrect level of care
The role of the physician advisor
Strategies for achieving accurate reimbursement
The appeals process for denied claims
Using data to determine improvement opportunities
Quick and not so quick fixes for incorrect "site of service"
Strategies for achieving accurate reimbursement
CD-9-CM codes qualifying for separate observation payment
Inpatient Only List
Site of Service Decision Making Flow Chart and Text
Rhode Island Hospital (OIG) case example
Utilization Review Committee (Medicare Conditions of Participation)
Primaris Non-Physician Review worksheet
Transmittal 299 Condition Code 44
MLN Matters Clarification Condition Code 44 SE0622
ABN
and more

Observation Status: A Guide to Compliant Site of Service Designations is a valuable, must-have resource for:

case managers
directors of case management
directors of nursing
nurse managers
medical directors
physician advisors

Deborah K. Hale, CCS, president of Administrative Consultant Service, LLC (ACS), has twenty five years of experience in health care management including administration, health information management, clinical documentation improvement, case management, and utilization review. She is a member of the American Health Information Management Association and the Health Care Finance Management Association.

Earn 3 Nursing Contact Hours! HCPro is accredited as a provider of continuing education by the American Nurses Credentialing Center Commission on Accreditation. Learning objectives:

Provide a historical overview of observation status
Identify services that are covered as observation status
Identify services that are not covered as observation status
Distinguish between an appropriate observation patient and an appropriate inpatient admission for both medical and surgical patients
Determine the role of admission screening criteria in establishing medical necessity of admission
Recognize appropriate wording for a level of care physician’s order
Recognize the impact of incorrect level of care determinations on the hospital, physician, and patient
Identify CMS’s strategies for measuring level of care accuracy
Identify strategies to facilitate appropriate level of care determinations
Overcome obstacles to effective staff education
Identify the responsibilities of a physician advisor
Determine methods to choose an effective physician advisor
Evaluate internal and external data sources to measure level of care variance
Implement improvement strategies based on data findings
Recognize reimbursable and packaged services provided to patients in observation status
Identify critical omissions in observation billing
Compare a Medicare reopening with a Medicare appeal
List the steps required to file a Medicare appeal

With more than 18 years of experience, HCPro, Inc. is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. The company's mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry. As an acknowledged industry authority in healthcare regulation and compliance, HCPro focuses on providing its clients assistance and expertise in the areas of accreditation, medical staff affairs, credentialing, privileging, medical record management, regulatory compliance, nursing, quality/patient safety, infection control, and workplace safety.

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