23. August 2012 · Comments Off · Categories: Health Law · Tags:

In its OPPS rule for 2013, CMS has asked for comments from hospitals as to whether there would be greater clarity “regarding patient status if there were more specific criteria for patient status in terms of how many hours a patient remains in a hosptial.”  In other words, would a “bright-line” test of, say, 24 hours determine whether someone is an inpatient under all circumstances? 

Clearly, the Recovery Auditors target “inpatient cases” becasue denials of inpatient status result in income for RACs. 

It is possible that a bright line test would result in a change of emphasis from review of the setting to review of the appropriatness of medical necessity.  Stay tuned – but comments are due September 4.

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