OpenPlacement Community > Questions > Tagged: Outpatient

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

Outpatient Case Management

asked January 31, 2014 | 0 followers | follow | 2 answers

I’d like to hear from any hospital case management department that has out-patient case management responsibilities that would go beyond typical case management discharge planning activities such as setting up homecare, sub-acute rehab, etc. We would like to hear what you have to say so we can learn more. Thanks in advance.

Scenario for Options

asked January 22, 2014 | 0 followers | follow | 3 answers

Here’s a scenario: A person who is 67 years old, alone, Medicare, minimal finances. Intractable back pain, scheduled Norco controls pain, difficulty getting from bed let alone walking. Outpatient MRI shows lytic lesions, new compression fx (prob related to lesions). Now prostate nodule found. Needs bone bx. Not covered as an inpatient procedure. What do we do???  Can’t care for self at home, no money for private pay SNF, no real qualifier for 3 day stay, do we do biopsey and eat cost or force to do as Outpatient?

Changing IP to OBs

asked December 19, 2013 | 0 followers | follow | 2 answers

If you have a patient who was admitted IP and was justifiably IP but then ceased to meet IP criteria, lets say after day 3. Do you change the status to observation/outpatient? I have always thought, no you wouldn’t change the status, but if you don’t change the status do your CM’s do a concurrent review and not cite any criteria? Please let me
know your thoughts!! Thanks in advance!

Outpatient Procedures

asked December 11, 2013 | 0 followers | follow | 2 answers

Any outpatient surgery: After 4-6 hours or 4-8 hours recovery do we need to call the MD to get another order for the outpatient as they will be spending the night or can we wait the 23 hours and avoid that phone call? How do your orders read when the patient is coming to the floor from outpatient surgery? Thanks!

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?

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