Wiki Hospital Inpatient Stay for 5 hours

Create Wiki Sort by date
W

Woakes73

Contributor
Messages
14
Location
Norwich, Connecticut
Best answers
0
I have a hospital bill for 1 day of inpatient services. The member came through the ER at 02:00 and passed away at 07:00 on the same day he had multiple surgeries while he was at the hospital.
My question is Can the hospital bill for a 1 day stay when the member was only in the hospital for 5 hours total before passing away. Between being in the ER and having 6 cardiac surgeries and recovery time I'm not understanding how they can bill for Rev code 0210 Coronary Care Unit.

Thank you for any help!
 
0
By my understanding, inpatient status is determined by the acuity of the patient’s condition and not by the amount of time spent in the facility. Physicians admit patients to inpatient if the expectation is that the patient’s condition will require more than two days of care, but that doesn’t mean that it will always be the case that they will remain in the facility that long. They don’t necessarily revert back to an outpatient service when something happens that causes the stay to end early.
 
0
thomas7331 said:
By my understanding, inpatient status is determined by the acuity of the patient’s condition and not by the amount of time spent in the facility. Physicians admit patients to inpatient if the expectation is that the patient’s condition will require more than two days of care, but that doesn’t mean that it will always be the case that they will remain in the facility that long. They don’t necessarily revert back to an outpatient service when something happens that causes the stay to end early.
Click to expand...

I agree. Also, a discharge status code 20 would be used to indicate that the patient expired during the stay.

As an example, Novitas defines a patient discharge: A “discharge” occurs when a Medicare beneficiary leaves an acute care hospital after receiving acute care treatment; or dies in the hospital.


In terms of the claim reimbursement, the payer contract may allow for the claim payment to be adjusted due to the length of stay and discharge status. The facility may not necessarily get paid the full DRG.

However, if the patient was admitted, it is accurate to indicate the inpatient status on the claim.
 
0
sls314 said:
I agree. Also, a discharge status code 20 would be used to indicate that the patient expired during the stay.

As an example, Novitas defines a patient discharge: A “discharge” occurs when a Medicare beneficiary leaves an acute care hospital after receiving acute care treatment; or dies in the hospital.


In terms of the claim reimbursement, the payer contract may allow for the claim payment to be adjusted due to the length of stay and discharge status. The facility may not necessarily get paid the full DRG.

However, if the patient was admitted, it is accurate to indicate the inpatient status on the claim.
Click to expand...
Hi, thank you both for your help. Also, yes the discharge status is 20 on the claim with a DRG of 215. The facility is billing at 100% of the repriced amount.
 
You must log in or register to reply here.
Top