Observation care

Colliemom

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We just received notification from Healthnet that they are now going to be monitoring our hospital admissions because they have a new policy regarding observation care.

So my manager asked me to find out how many other offices are now billing observation care codes instead of hospital admission codes? Are you changing the way you care for your patients based on the new policies going into effect? (meaning that patients in the past who you would have admitted for a hospital stay are now being sent to the hospital for observation status)

For those of you billing the observation care codes, are you having difficulties getting reimbursed?
 

ARCPC9491

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I don't know anything about Healthnet, yet - if others are experiencing, please share!!:)

What I can add is - the troubles with getting paid. I have a client that consists 25 hospitalists - getting them on the same page as the hospital is difficult sometimes. What I mean by that is - sometimes the physicians will bill an admission (99221 - 99223) when per the hospital, they were admitted to observation, not admitted as inpatient. The reverse happens a lot too - the docs will bill for initial observation, when in fact it was an inpatient admission.

This has a great impact on the payment because for example, for commercials, most plans require preauth or precert for inpatient admissions. Well, if the docs get mixed up and bill an admit - we'll get that denial for not precertified/preauthed. Then after investigation, we realize, it was observation!

Also, most "chest pain" patients are admitted to observation first - (Is that how other hospitals do it? that's the new protocol here... unless of course the patient is having an MI, that's different... just complaints of chest pain is what I'm speaking of....) We have had difficulty with payers in the past, stating that after review of records, the patient should not have been admitted to inpatient. We typically get this for chest pain, but we also get it for other problems.

I don't know if I helped you out or not, but those are my observation issues!!! :)
 

Colliemom

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Thank you, I was worried about the exact issues happening with our practice. I am worried about the doctors report admits when the patients are actually observation and observation when they are actually admits...
 

ARCPC9491

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I would love to know what others have put into place to prevent this from happening - so many times does the docs charges conflict with the hospital! it's hard to catch on the front end and a burden on the back end!

Any suggestions?
 
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