Author Description

Patient Status Pocket Cards for Physicians Kimberly Anderwood Hoy Baker, JD, CPC Ralph Wuebker, MD, MBA Steven Greenspan, JD, LL.M Purchase a pack for your physicians and case managers today! This pocket card will help physicians determine the appropriateness of an inpatient admission based on expected length of stay through a series of guidelines and a decision tree chart based on Medicare regulations. Healthcare professionals can carry the laminated card in a lab coat pocket and refer to it when determining whether a patient should be admitted as inpatient, be placed in observation, or receive outpatient services. Inpatient orders are a condition of Medicare payment and evolving requirements make determining patient status an ongoing challenge. CMS' 2014 IPPS final rule redefined inpatient admissions by implementing the 2-midnight rule, which requires a validated physician order, documentation of medical necessity, and the expectation of a stay crossing two or more midnights. However, the 2015 OPPS final rule changed this requirement so that as of January 1, 2015, physician certification is only required for long-stay cases that are expected to last at least 20 days, as well as outlier cases. This pocket guide will help you do the following: Determine whether inpatient admission is appropriate for a patient Recognize requirements for hospital level of care Understand best practices for physician documentation Differentiate outpatient and observation guidelines Table of Contents Recommended Medicare Admission Review Decision Tree Best practices for physician documentation inpatient versus observation ordering guidelines Guidelines for surgical cases (does not apply to procedures on CMS inpatient-only list)