Observation status is not determined by a facility; it is directed by the physician's order. Most facilities have Case Management / Clinical Documentation Specialists who review the medical records real time and converse with the physicians regarding the medical necessity of the patient. However the bottom-line is that a physician's order is the determining factor for observation vs. inpatient status. If the medical necessity of the patient's condition does not meet inpatient criteria but the patient is not able to be discharged, there is no other choice than to continue the patient in observation status. This status does impact the Medicare payment a facility receives, but the physician will be paid per E&M billed. As you know, AMA did add new E&M codes for observation services for 2011, and these codes are payable under the MPFS.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join