Catalog Number : cca1869
Title : Observation, IP vs. OP: Compliance and Proper Billing
Speaker : Duane Abbey

Duration : 90 minutes

Webplay Recording Date : 1-15-2014
Webplay Price : $ 200 for two weeks viewing

Webinar Overview:

Just what is Observation? What constitutes as Inpatient Admission? How should a physician determine that Observation should be used rather than Inpatient Admission? To answer these questions and more please come join us in this upcoming Webinar.

Target Audience:

Outpatient Nursing Staff, Medical/Surgical Nursing Staff, Nurse Managers, ED Nursing Staff, Utilization Review Personnel, Quality Assurance Personnel, Quality Assurance Personnel, Physicians, Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, and Other Interested Personnel

Webinar Objectives:

To discuss the issue of what constitutes an inpatient admission
To review physician requirements for inpatient admissions versus outpatient observation admissions
To briefly review inpatient admission criteria including CMS's new 'over 2-midnights' rule
To review the observation concept and payment for observation services
To review various Medicare rules and regulations concerning observation services including counting hours, Condition Code 44, and documentation requirements
To appreciate how the Medicare interpretation of Condition Code 44 is different from private payer interpretations and usage
To review the O'Connor Hospital Ruling from the Medicare Appeals Council
To understand how CMS has reacted to the O'Connor Hospital Ruling and similar appeals
To appreciate how CMS wants to address Part B inpatient billing as discussed in Federal Register entries
To discuss the 1-year timely filing requirement
To review CMS's stance on the scope of review for federal auditors
To discuss the Utilization Review Committee involvement in observation and for changes in inpatient status after the patient's discharge

A few of the Topics that will be covered:

Inpatient vs. Outpatient Status
- Inpatient Admission Process
- Medical Necessity Documentation
- Standardized Inpatient Criteria
- Compliance Issues
- Payment Documentation
- RAC Involvement
- CMS' Fundamental Premise
O'Connor Hospital Ruling
- ALJ and MAC Rulings
- Directives Made to CMS
- CMS Acquiesce to the Rulings
August 19, 2013 Federal Register
- CMS Fundamental Differences with Rulings
- Ruling Making Process
  - Interim Rule - CMS-1455-R
  - Proposed Rule - CMS-1445-P
  - Transmittal 1247
  - Final Rules in IPPS for FY2014
Issues and Directives
- Hospitals Are Solely Responsible For Correct Claims
- Scope of Federal Auditors
- Over 2-Midnights Rule
- Part B Inpatient Billing
  - Conditions Code 44 Situations
  - Auditor Denial Situations
  - Hospital Self-Audit Situations
- 1-Year Timely Filing Requirement
- Categorization of Services Requiring Outpatient Status
CMS' Conformance With Directives in the Rulings
Additional Issues and Concerns
- Correcting Errors
- Developing Payment Documentation
Case Studies and Exercises

Attendance Certificate:

Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program.

Refund Policy:

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.

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