Inpatient Facility Coding & Compliance Alert

Take this primer and stay clear of RACs by correctly classifying patients. If you're fuzzy on the distinctions between inpatient and outpatient status, it's likely that you're headed straight for audit scrutiny. Understand the answers to these four questions to ensure you won't gain extra RAC (recovery audit contractor) attention by filing too many claims changing a patient's status from inpatient to outpatient. Why it matters: When a patient is admitted to a hospital and receives inpatient services, the hospital is paid through MS-DRGs, explains Duane Abbey, Ph.D., president of Abbey and Abbey Consultants, Inc., in Ames, IA. If auditors later determine that the inpatient admission wasn't justified, the RAC demands that the hospital return payment. "The hospital can't bill for what should have been observation care because Condition Code 44 wasn't used originally," Abbey says. 1. What Does Condition Code 44 Mean? If you determine that a patient has [...]