ppt课件-gettingitrightthefirsttimedocumentationofmedical.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * Getting it Right the First Time: Documentation of Medical Necessity for Short Stay Patients Steve Lokensgard Special Counsel Faegre Benson David Orbuch President Phillips Eye Institute fb.us.3575960_2 * AGENDA The Need to Get This Right! Medicare Criteria for Inpatient Admissions Process for Small Hospitals Process for Large Hospitals or Health Systems * AGENDA The Need to Get This Right! Medicare Criteria for Inpatient Admissions Process for Small Hospitals Process for Large Hospitals or Health Systems * The RAC Demonstration Top Services with RAC-Initiated Overpayment Collections Treatment in wrong setting for: Surgical procedures $88 million Cardiac defibrillator implants $64.7 million Heart failure and shock $33.1 million Wrong setting means the patient could have been treated on an outpatient basis Accounts for almost 20% of the RAC overpayments * Non-RAC Reasons to Document Correctly December, 2007 St. Joseph’s Hospital pays $26 million to the federal government to settle a qui tam lawsuit involving short stays not medically necessary June, 2008 75% of one-day stays for chest pain in the State of Minnesota were not medically necessary and could have been treated on an outpatient basis according to Stratis Health, Minnesota’s QIO State False Claims Act Quality of Care * AGENDA The Need to Get This Right! Medicare Criteria for Inpatient Admissions Process for Small Hospitals Process for Large Hospitals or Health Systems * Medicare Criteria for Inpatient Admissions No magic language to document “Neither the statute nor any applicable regulation defines “inpatient.” CMS’s policy manual defines an inpatient as a person who has been formally admitted to a hospital.” Landers v. Leavitt, 545 F.3rd 98 (2nd Cir., 2009)(emphasis added)(referring to the Medicare Benefit Policy Manual) * Medicare Criteria for Inpatient Admissions Medicare Benefit Policy Manual, ch. 1, § 10 24-hour benchmark Complex