Observation status changed to inpatient

myu1@valleyhealth.commyu1@valleyhealth.com
in CDI Management

Our CDI program is seeing patients who are in observation status  and being flipped to inpatient and then discharged on the same day and we are unable to review these cases. Our CDI program only cover patients when they are still in house. we do not follow up once they are discharged. Is there anyone in a similar situation? What do you do to manage this issue?

Comments

  • jcjohnson@premierhealth.comjcjohnson@premierhealth.com

    Good Afternoon, I feel this likely happens for many CDI programs. I would reach out to your UM/Case management team to discuss. As traditional Medicare patients get inpatient via the 2-Midnight Rule, other payers require that strict criteria be met. I would want to ensure that your facility is receiving inpatient payment on these cases and also prevent medical necessity denials. Collaboration may help inform your team in a more timely process as to when an inpatient order is received.


    Best Regards,

    Jeanne

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