johncyrose
Contributor
Just wanted to find out from others what their experience had been in this situation and what have been done to get these claims paid.
We have an IPA denying our claims stating that patients are only authorized for short stays. Pt has been admitted to inpatient after the admitting physician saw the patient for initial evaluation in the ER. The patient was in the hospital for 3 days. I understood that per Medicare guidelines, I am able to use 99234-99236 or 99218-99220 for stays less than 24 hours within the same calendar day. I understood that if it's more than that (up to 72 hours, rarely more), I can use the appropriate observation codes if during that period the patient remained in observation/outpatient status in the hospital. I am not sure what to do to get our inpatient claims paid given their short stay authorization but was admitted as inpatient. I code for the physician services.
I was wondering if the facility should have done something to update the IPA of the change in the patient's status as soon as it changed from obs/ER/outpatient to inpatient to get authorization for the inpatient stay, and there's nothing we can do if that didn't happen and the patient has already been discharged.
Appreciate your inputs.
We have an IPA denying our claims stating that patients are only authorized for short stays. Pt has been admitted to inpatient after the admitting physician saw the patient for initial evaluation in the ER. The patient was in the hospital for 3 days. I understood that per Medicare guidelines, I am able to use 99234-99236 or 99218-99220 for stays less than 24 hours within the same calendar day. I understood that if it's more than that (up to 72 hours, rarely more), I can use the appropriate observation codes if during that period the patient remained in observation/outpatient status in the hospital. I am not sure what to do to get our inpatient claims paid given their short stay authorization but was admitted as inpatient. I code for the physician services.
I was wondering if the facility should have done something to update the IPA of the change in the patient's status as soon as it changed from obs/ER/outpatient to inpatient to get authorization for the inpatient stay, and there's nothing we can do if that didn't happen and the patient has already been discharged.
Appreciate your inputs.