CMS ALERT for PHYSICIANS & PROVIDERS! - Munson Healthcare

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Oct 1, 2013 - MMC has a team, including physicians, working to redesign admission orders and processes to assist in this
CMS ALERT for PHYSICIANS & PROVIDERS! CHANGES TO REQUIRED ADMISSION PRACTICES - OCTOBER 1, 2013 The 24-hour stay benchmark, which traditionally marked the threshold for an INPATIENT stay, will become two midnights. This change is required for Medicare patients. INPATIENT RULE CHANGES Effective Oct. 1, 2013, an INPATIENT admission is defined as a patient requiring a hospitalization “encompassing two midnights” AND supported by medical necessity. o Severity of illness must require two midnights in the hospital. o EXAMPLE: An overnight stay in ICU is considered OBSERVATION unless the patient stays for a second midnight based on medical necessity. Medical cases with an expected length of stay not spanning two midnights will not qualify as INPATIENTS and will not be eligible for payment under Medicare Part A. o EXCEPTION: Surgeries/procedures on Medicare’s “INPATIENT ONLY” list remain INPATIENT, regardless of length of stay. The 3-day INPATIENT stay to qualify for Skilled Nursing Facility (SNF) placement has not changed. OBSERVATION CHANGES An “ADMIT TO OBSERVATION” order is required. After one midnight stay, all Medicare OBSERVATION patients should be considered for discharge or advanced to INPATIENT status based on medical necessity. An OBSERVATION midnight or an ED midnight counts toward the two midnight INPATIENT total when there is medical necessity for INPATIENT admission.

CMS ALERT for PHYSICIAN & PROVIDERS! CHANGES TO REQUIRED ADMISSION PRACTICES - OCTOBER 1, 2013

WHAT YOU NEED TO DO You need to order INPATIENT admission for Medicare patients if: o You expect your patient’s length of stay will exceed the two midnight benchmark AND there is medical necessity; or o o

Your patient requires a procedure specified by Medicare as “INPATIENT ONLY”. NOTE: Midnights spent in ED or OBSERVATION count toward the cumulative midnights to qualify as an INPATIENT

You need to complete four key components to certify that a hospital INPATIENT service is reasonable and necessary. 1. Complete and sign an admission order. o The INPATIENT stay does not commence until an “ADMIT TO INPATIENT” order is written. o Your order must specify “ADMIT TO INPATIENT” only. Orders noting the unit (“ADMIT TO A4” or “ADMIT TO ICU”) will not meet requirements. o

Your order must be executed via an admission Power Plan.

o

A surgical boarding slip (Form 2097 - Scheduling/Order Info.) is not an admission order. 2. Document the reasons for INPATIENT hospitalization/service. o Include a specific diagnosis (being as detailed as possible). 3. Document the estimated time you expect your patient will require hospitalization. o Support with evidence in the medical record. 4. Document your plans for post-hospital care, if appropriate. You may use the H&P, Progress Notes, Discharge Notes, and PostPlan of Care to document medical necessity for INPATIENT status. You need to complete and sign all of the above documentation prior to your patient’s discharge. A tool to simplify the signature process is in progress. MMC has a team, including physicians, working to redesign admission orders and processes to assist in this transition. Please watch for additional information in the coming weeks. CMS ALERT for PHYSICIAN & PROVIDERS! CHANGES TO REQUIRED ADMISSION PRACTICES - OCTOBER 1, 2013