Status changes
In order to upgrade a patient from observation to inpatient, you need 1 or more of these 3 things.
Meeting inpatient per MCG criteria.2nd midnight obs pt meeting local UM criteria. A referral to a PA who recommends an inpatient status change.
What is the most commonly used variance?
What's a surgery where the patient typically only stays 1 day but is always inpatient?
Carotid endarterectomy.
When can we retro an inpatient status change?
Generally never. Only exception is a clarification order if the PA disagrees w/the previous downgrade in status.
After how many days of comfort care or medical stability do we send to PA review?
2.
When downgrading from inpatient to observation on a Medicare or Medicare advantage pt, this process is required.
CC44
What variance does Sarah never want to see?
Other
What 3 things should be in your note on the authorization line?
Approved (status), Auth #, range of dates.
When can we retro an observation status change?
Commercial patient to the time of arrival to the unit! Must note this in your order and place a HAR.
*On admit*
What patients do we always send to PA review?
Inpt non-op fx, chest pain, delirium.
A PA has determined an obs status is appropriate for your patient. What are your next steps?
Contact the provider, place the order, update EM, place a HAR, update your secondary review tab.
When do you use the delay of admission or transfer variance?
Only when patient is medically stable awaiting DC.
Where do you find the ASA score?
Anesthesia report.
What is the only status change in which you do NOT write "status effective date/time?"
CC44
What patients do we NOT send to PA when no longer meeting medical necessity for continued stay?
INPATIENTS awaiting DC to SNF, Inpatient Rehab or LTAC.
What are the steps of a CC44 process?
PA review, place on CC44 log, contact provider, wait an hr, contact provider again, wait an hr, place order, update EM, place HAR, request MOON delivery, document final prog and HAR.
Where should you check for surgical status variances?
Theresa's note! Under UM notes tab.
True/false: The inpatient order can be written any time during a planned inpatient surgery stay.
True and false. CAH orders must be before surgery. DRG hospitals can be any time during their stay.
Your patient is intubated. What status should they be?
Inpatient.
If you send a pt who is not meeting c/s to PA review and the PA says keep inpt awaiting an ICF, what are your next steps?
If an attending does not call you back, what should you do?
Wait an hour. If they do not call back, change the order. If a CC44, you must attempt contact twice.
Which variances need notes?
Delay of admission or transfer (SNF, ICF, ect)
Poor physiology
Where are ALL of the places you can find the CPT code?
Surgery note, auth note, auth/cert screen, referrals (under chart hx), Carol Kerr
What insurance has an exception clause where if the patient does not stay a midnight as inpatient, even if intubated, we do not get to charge inpt charges?
IHN
What information does the PA need to include if their determination is no longer meeting for c/s?
The date they no longer meet c/s!