Wiki No reimbursement after first day of observation

[tilquist3@comcast.net]

We are not getting reimbursement after the first day a patient is in observation. Patient is in IL and has Medicaid. Any idea why?

 

[iowagirl77]

Take a look at their handbook online- https://www2.illinois.gov/hfs/SiteCollectionDocuments/a200.pdf :

A-220.4 Hospital Observation Care A practitioner may charge for hospital observation care by using the appropriate CPT codes and in accordance with CPT guidelines. If the participant is admitted to the hospital on the same service date as the observation, a charge may be submitted only for the initial inpatient visit. No payment will be made for the observation services. If the participant is seen in the emergency room and placed in observation by the same practitioner, a charge may be submitted for the observation care only. Payment will not be allowed for observation care for consecutive dates of service. Also, only one observation CPT code may be billed. The code for observation care “discharge” is not a covered service. Payment is not allowed for observation care for obstetrical cases in labor if the participant is admitted to the hospital from concurrent observation and delivers the same day.