Scenario:
Hospitalist is the attending, rendering services for multiple chronic conditions. Discharge service provided on 3/1. Patient is kept in the hospital for 3 days pending nursing home placement. Med Staff policy states attending MUST see the patient every day. In my opinion, the addition 3 days are non-billable due to a lack of medical necessity. I have found CMS reference to support the facility biling for this circumstance, but not the physician billing.

Thoughts?

Scenario 2:
Hospitalist is the attending, rendering care for multiple chronic conditions. Cardiologist is also following patient. Hospitalist renders discharge service on 3/1 and states "D/C per cardiolgogy clearance". The patient was not cleared by cardiology due to an abnormal EKG, and was kept for an additional three days. In my opinion, the services would be medically necessary, as they were not cleared by cardiolgoy due to an abnormal EKG, for which additional studies were performed. Again, in my opinion, I believe the Hospitalists should re-document the discharge summary to re-capture what occurred in the 3 day time frame.

Thoughts?

I guess I am focused on if the services were really medically necessary or just part of Medical Staff policy. Any thoughts or references greatly appreciated!