Medicare Compliance & Reimbursement

Hint: Roll office visit, observation stay into one code. Physicians are admitting more patients than ever to observation status -- so Medicare analysts will be scrutinizing these claims like never before. Many hospitals have tightened the criteria of what constitutes an inpatient stay -- causing some patients to linger in observation care for longer than the average period --in some cases up to two weeks, according to a Dec.11, 2008 notice from the Center for Medicare Advocacy. As hospital policymakers set standards regarding which patients qualify for observation care and which should be inpatients, Part B coders need to ensure that their observation coding practices are pristine, because all eyes are focusing on claims for these services. 1. Bill just one E/M visit: If your physician sees a patient in his office and decides to subsequently admit that patient to observation status, you cannot report both the office E/M (e.g. 99213) and [...]