POA when status changes
The coders and I are struggling with a POA question especially with all of the MA plans we now deal with. How do you deal with POA when the patient starts as observation but then something develops to change the patient to inpatient but since it is insurance or MA plan our UR department rolls the admit date back to when the patient walked in the door. Here is an example, patient placed in observation on 8/13 for weakness and is basically a social admit for placement. Then on 8/15 patient aspirates and we start treating aspiration pneumonia. Doctor writes order for inpatient. UR makes the admission date 8/13. Technically the pneumonia is the reason for the inpatient but the date goes back 2 days before the aspiration event. Help! if you have a source that explains please share especially is you have anything that would help me with a discussion with the UR department.
Comments
I was always under the impression that when an IP admit order is present and signed that order date is the date of the IP admission.
It seems strange that UR is using a date 2 days before the IP order was placed (if I’m understanding correctly).
These references may help you have a discussion, and maybe UR knows something I’m unaware of that supports the date selected… CMS rules are pretty confusing, to be fair, but they generally do not allow retroactive inpatient orders; admission to the hospital generally begins with a prospective order, typically at or before the time of the patient's formal admission. While a doctor's decision to admit may consider time already spent in the hospital as an outpatient, I don’t believe the actual inpatient admission can begin before an order is documented in the medical record. [4]
Hope this helps!
-Inpatient admission begins on “the day on which the patient is formally admitted as an inpatient with a signed and dated physician order. “ [1]
-”The physician order must be furnished at or before the time of the inpatient admission” [2]
-”To add to the confusion, in the Medicare Benefit Policy Manual, CMS has also told us that on rare occasions, a Part A inpatient claim can be submitted for a hospital stay when the inpatient admission order is missing, as long as intent to admit can be established. So even those three magic words, “admit as inpatient,” are not an absolute requirement.
“So, where does this leave us? The patient is an inpatient once formally admitted as inpatient, but the placement of an admission order does not constitute formal admission, the delivery of the IMM does not constitute formal admission, and even if an admission order exists and the patient receives “inpatient care,” they were not considered to be formally admitted if the admission order was not countersigned.” [3]
[1]https://med.noridianmedicare.com/web/jea/provider-types/acute-ipps-hospital/admission-date-and-statement-covers-period-billing
[2]https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-412/subpart-A/section-412.3
[3]https://racmonitor.medlearn.com/when-does-a-patient-become-an-inpatient/
[4]https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/downloads/ip-certification-and-order-01-30-14.pdf