Wiki Observation to Admit Status for Medicare Patient

mamoore56

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Previously if a patient was admitted for an observation status which turned into an admit status, an office would bill the admit charge as it was the highest level. However, there are some changes with Medicare and the guidelines of observation and 2 midnight stays? Can someone tell me what has changed with Medicare and how the claim should be billed. The office is getting rejects from Medicare for the admit charges. With these changes, does it only apply to Medicare or other carriers? I appreciate any responses!
 
OBS to IP for Medicare Patients & 2 MN Rule

The 2 MN Rule was implemented by CMS for Medicare patients; however, some Medicare Advantage and other commercial payers try to apply the same concept as a rationale for denying short IP acute hospital stays - stays less than 2 midnights.

This URL is a link to a simplified presentation of the 2 MN Rule that you may find helpful.
http://www.racsummit.com/readings/2014 IPPS Final Rule for Dummies.pdf

Essentially, 2-MN rule is a condition of payment that states the a hospital stay must be 2 midnights or longer to qualify as an IP admission payable under IPPS / Medicare part A.

Vickie Wilkerson
Secretary 2016
AAPC-Richardson Chapter
 
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