The number of Medicare beneficiaries entering hospitals as observation patients doubled between 2006 and 2014 to nearly 1.9 million, according to figures from the Centers for Medicare & Medicaid Services (CMS). Because observation care is coded and billed on an outpatient basis, patients usually also have co-payments for doctors’ fees and each hospital service, and they have to pay whatever the hospital charges for any routine drugs the hospital provides.
Because observation coding, billing and documentation continues to be a problem area, the CMS has developed a packaged payment process using a C-APC code that makes a blanket payment for observation services. Whether hospitals even recover their costs under this packaged approach is questionable, given the extreme variability of services and the host of challenges with determining proper inpatient admissions.
This webinar will examine the most recent information from the CMS regarding differences between a short inpatient stay and observation, including:
- The need for documentation to support the coding and billing process to receive proper reimbursement
- Proper use of C-APC 8011 in payment for observation under the outpatient prospective payment system
- The influence of the two-midnight rule on medical decision-making
- The effect on Medicare reimbursement of a procedure performed after observation
- Requirements in the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act
- Differences in reimbursement between a short-stay inpatient encounter and an observation encounter
Meet Your Faculty
Duane Abbey, PhD, CFP, is president and management consultant of Abbey & Abbey Consultants, Ames, IA. For more than 20 years, Abbey has provided healthcare consulting services to hospitals, physicians and medical clinics in the areas of compliance and payment.
Who Should Attend
Directors of outpatient services, coding and reimbursement personnel, compliance officers, Chargemaster coordinators and medical record auditors
$195 per MHA member; $295 for non-MHA members
Members are encouraged to register by noon, Feb. 5.