Confusion ahead as CMS changes inpatient criteria.

Link to article at PubMed

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Confusion ahead as CMS changes inpatient criteria.

Hosp Case Manag. 2013 Oct;21(10):133-6


In the Inpatient Prospective Payment System final rule for 2014, the Centers for Medicare & Medicaid Services established a benchmark of two midnights for an inpatient admission and issued robust requirements for documentation. Case managers must work closely with physicians to ensure that the documentation includes the expected length of stay, the rationale for hospital treatment, the treatment plan, and a written order for admission. Case managers must review every admission within 24 hours to make sure the hospital doesn't lose reimbursement. Auditors will be looking for incidents where hospitals keep patients over two midnights when it's not medically necessary in order to get inpatient reimbursement. CMS continues to emphasize quality in care.

PMID: 24195133 [PubMed - indexed for MEDLINE]

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