Why is this Still a Problem?
FREE WEBINAR
Join us July 27, 2017from 12:00pm to 1:00pm EST
Level of Care Decisions: Inpatient versus Outpatient Observation-Why is this Still a Problem?
Getting the Level of Care “Right” at the Outset, Responding to Denials and Getting Paid
Region 2 will be hosting a FREE web-based presentation
Hospital providers remain confused about assigning patients to an inpatient level of care vs. outpatient observation. Different payers are using different criteria to guide the decision-making process, leading to additional process haziness. Providers that err on the side of short stay inpatient admission, are often plagued with managed care and retrospective Fee for Service Medicaid admission denials. Medicare Fee for Service has initiated QIO oversight of the two midnight definition of inpatient admissions, and we remember the recent Medicare RAC level of care audits. Providers that err on the side of outpatient observation may be self-denying appropriate inpatient reimbursement. The waters get even muddier, when providers need to adjust claims after denials, trying to get any reimbursement at all.Marry this, with Medicare and State requirements for patient notice upon placement in observation, and Medicare rules for only changing a level of care determination while the patient is still an inpatient, and you get a ‘perfect storm’ for diminished reimbursement and administrative burden. Hear the issues, the best practice guidance across payer lines, and re-billing opportunities.
About the Speakers:
Ellen Scott, R.N., Director of the appeals management practice (PARR) at Health/ROI. Health/ROI is a healthcare recovery and consulting firm, with offices in New York and New Jersey. Ellen is a nurse by training and as Director of PARR for the last 16 years, Ellen is a specialist in utilization management, clinical documentation, and insurance and arbitration issues. The practice successfully assisted 70 Hospital clients in 4 states challenge Medicare denials pursuant to RA, CERT and MAC Medicare audits. Her practice continues to challenge and appeal current managed care, Medicaid and Medicare short stay admission denials with a keen eye to future audit and reimbursement issues related to the denials and care management.
Jayshree Patel, CPC is the Director of Outpatient Services at Health-ROI. Jayshree is a recognized expert in Outpatient Coding, Compliance, and Reimbursement. Currently she is responsible for Ambulatory Payment Classification (APC) and Revenue Recovery with more than 18 years’ experience and detailed knowledge of coding, compliance, auditing, recovery, and education in provider and outpatient hospital settings.
For more information and to register, visit the following link:
https://attendee.gotowebinar.com/register/4496052961953510915
Space is limited.
Registration is FREE to both HFMA Members and Non-Members: CPE Credits: 1.0
In order to receive CPE credit for this session you will be required to register and log on to the event individually.
Additional Contact Information:
Shivam Sohan (516) 562-6000 x5079
Please note that handouts, links and dial in information for this session will be sent 24-48 hours prior to event.
NYS Education Department Sponsor License # OOO3377
HFMA Metro New York Chapter is approved as a New York State CPE Provider in the area of specialized knowledge and applications. In accordance with the standards of the National Registry of CPE Sponsors, the total credits have been rounded down. CPE credits have been granted on a 50-minute hour.