It is perhaps the most vexing issue for providers, hospitals and patients: the effect of merely classifying a hospital stay as either Inpatient or Outpatient.
Certainly, to patients, this is the veritable “distinction without a difference” – except the patient feels the difference in their pocketbook.
For providers, it is not much easier to determine a proper patient status - whatever that means. For the delivery of care, an inpatient environment is certainly capable of more intensive care, while an outpatient environment is less so, by definition, and indeed in reality is not as capable, albeit not very far away from being so, in many locations.
After spending more than a decade teaching and/or discussing the difference, Dr. John Zelem, Glenn Krauss, and Ernie de los Santos have all seen many providers and hospital revenue cycle professionals left with wondering how to enact a system of both thinking about the differences, and enabling processes to choose a proper patient status. How does one create something like that, that is systematic, reliable, efficient and adaptable? The endeavor seems more like an infinite game of Whack-a-Mole than a studied, sensible method of applying business rules, much less achieving healthcare's enshrined Triple Aim.
In this one-hour talk, the presenters review Inpatient and Observation definitions, documentation requirements and billing concepts. Of course, the permutations of the infamous 2 Midnight Rule are discussed, as well as the pitfalls of attempts to use its so-called Exceptions. The critical roles of Utilization Review and Utilization Management are reviewed with references to all the regulatory rules and guidance. And finally, the overall role of clinical documentation is defined, with keys, tips, examples and takeaways as to what constitutes "high-quality" documentation - that is, documentation that not only best communicates the story of the patient but also is able to survive payer audits for appropriate, deserved reimbursement.