OpenPlacement Community > Questions > Tagged: inpatient

Inpatient Falls

asked April 15, 2014 | 0 followers | follow | 3 answers

I am looking for advice on reducing inpatient falls… It seems the more we try, the more falls occur. Most of the falls are occurring on the medical-surgical unit. Although our fall rates for the year have been high in our ICU and SNF units as well. We have currently formed a sub-committee to review each fall and work towards ways to prevent in the future. Any thoughts are greatly appreciated!

Admission Orders

asked April 9, 2014 | 0 followers | follow | 2 answers

We have been having a lot of problems with re-work when it comes it assigning our patients status (inpatient/observation). We assign the status in the ED for registrations purposes, but the attending does not actually write on the chart until he comes to see the patient. Then the order may be different from the original registration order, which causes a lot of rework, anyone have a good system that we could look at or use?

ED Physicians

asked March 5, 2014 | 0 followers | follow | 3 answers

What has anyone done about ED physicians who just can’t get it straight what is OBS and inpt???? Chest pain we have said is generally OBS but they still put in for inpt… We do have CM 5 days a week 8 hours a day and hoping to expand on those hours. But I still don’t know what do about the adm status.

Case Scenario

asked March 3, 2014 | 0 followers | follow | 4 answers

7 year old child is admitted for video EEG. Physician places order for observation status, which is a mistake, since the physician have been educated on this topic before. Patient is discharged before order can be changed. Our billing office refuses to bill this as inpatient, despite my assurances that video EEGs are not done outpatient. The payer is a managed care payer and has already approved the claim as inpatient.

What would everyone do? Would you: A. Bill as outpatient because compliance is ‘king’ or B. Bill as inpatient because this was an obvious mistake and you will fight it out with the payer if they question it

Hospice Status and Inpatient Status Scenario

asked February 26, 2014 | 0 followers | follow | 3 answers

An 84 year old patient is on hospice at home for end-stage dementia. She develops aspiration and for an uncertain reason is brought to the hospital by EMS, where she is subsequently admitted with aspiration pneumonia (confirmed infiltrate on CXR). She is treated with IV antibiotics for 2 days and is discharged back home on hospice.

The patient’s insurance carrier, a Medicare managed care, says that the patient’s inpatient stay is not covered and gets billed to hospice. Is this true? The reason they give is that they are not required to cover the patient again until the first of the month. I have never heard of this.

Can anyone provide any insight or regulatory guidance into the scenario I have described above?

Newborn Admit Order

asked February 3, 2014 | 0 followers | follow | 1 answers

Does a newborn born in your facility require an “admit to Inpatient” order? Or is this implied?

Inpatient Only

asked December 3, 2013 | 0 followers | follow | 1 answers

Can someone help me with this issue? We have a surgery scheduled for debridement of sternum, which is an either/or procedure…. Physician does more and goes into the bone and now it is on the inpatient only list. We had them as an outpatient. How do other hospitals get it right? The coders don’t have the op note until the patient has been discharged. Any suggestions??

Blood Transfusions

asked October 10, 2013 | 0 followers | follow | 1 answers

How do other facilities handle patients who present for blood transfusions but the outpatient infusion center is closed and the ED will not accommodate them? My approach has been to just bill them as outpatient unless there is evidence of symptomatology which would warrant observation while they are transfused. Additionally, if there is active bleeding, and they are anemic and need transfusions, we would obviously make them inpatient. Any thoughts?

Chest Pain

asked September 3, 2013 | 0 followers | follow | 1 answers

Here’s a case:

83 year old female with a history of HTN, DM, CVA, and CAD (stents in 2000 and 2001) presents with left-sided chest pain radiating to the left arm and associated with dyspnea and diaphoresis. Enzymes are negative and ECG is unchanged. By the time the patient is admitted, chest pain is resolved and she does not receive any nitroglycerin, heparin or IV beta blockers. Cardiology is consulted and says her chest pain is ‘atypical’. She goes on to have an echocardiogram but no stress test or cardiac catheterization. Her LOS is 3 days.

So here’s the question…based upon this….OBS or inpatient? Feel free to ask for more information if need be.

Changing Orders

asked August 23, 2013 | 0 followers | follow | 2 answers

The longer I do this job, the less I understand it! Is anyone willing to share how they change the status order when it is put in wrong on a previous day for Medicare Advantage plans? i.e. doc writes an OBS order then case manager reviews case the next day and it qualifies for InPatient. What do you do after discharge? I understand I cannot back date or write a retro order on a straight Medicare patient. Thanks again!

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