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Medicare Compliance & Reimbursement

Industry Notes:

$6 Million Question for Denver Hospital -- 'Observation,' 'Inpatient,' Or 'Outpatient'?

Published on Tue Jan 31, 2012

When your physician admits a patient to the hospital, your coding work isn't done -- you need to know whether the patient was admitted as an inpatient, admitted to observation care, or admitted to the ER (which qualifies as outpatient care). That differentiation cost a Denver hospital over $6 million recently. Based on a whistleblower lawsuit, the OIG investigated the admission practices of a Denver hospital, which was alleged to be inappropriately admitting patients as "inpatients" when the patients were actually in outpatient or observation status. As most coders know, inpatient reimbursement can typically be higher than outpatient or observation pay. The hospital agreed to pay $6.3 million to resolve the allegations of impropriety, which occurred between Jan. 1, 2006 and Dec. 31, 2009, according to a Jan. 5 Colorado Attorney General press release. "It is crucially important for government health care plans to be efficient as possible," said U.S. Attorney [...]
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