Outpatient in a Hospital Bed: Effective Utilization Review and Billing Strategies

It’s a growing trend: patients who occupy a bed, but who no longer require hospital care. They reach this point via a number of scenarios — for example, as emergency department (ED) outpatients, as observation patients or even as inpatients. For a variety of reasons, these individuals cannot be discharged, so they occupy a hospital bed for days or even weeks. Unfortunately, no one knows how to properly handle admission status or billing for this type of patient. Consequently, revenue is sacrificed.

Conventional wisdom might suggest “outpatient in a bed” as a billing solution. But that would be wrong. From this RACmonitor webcast, presented by Dr. Ronald Hirsch, you’ll learn about this and other misconceptions, as well as how to compliantly bill for patients who receive hospital care without medical necessity. Dr. Hirsch will discuss a utilization review (UR) process that examines crucial aspects of these difficult situations, including required notices, compliant documentation, tracking days, special coding rules and billing nuances.

Why This Is Relevant:

How will you get paid for patients who occupy a bed without medical necessity? Your hospital’s financial health depends on it, yet you also must avoid noncompliant billing. During this exclusive RACmonitor webcast, Dr. Hirsch will present proven UR and billing strategies that encompass admission through discharge, using case scenarios to reinforce key concepts.

Learning Objectives:

• Understand the fallacy of “outpatient in a bed” as a billing term
• Identify various scenarios of patients in a hospital bed without medical necessity, drawing from case examples
• Learn about modifiers and condition codes applicable to these patients
• Grasp the elements of compliant documentation

Who Should Attend:

Utilization review staff, compliance professionals, case managers, nurses, physicians, physician advisors, chief financial officers, RAC coordinators, chief medical officers, social workers, and revenue integrity and revenue cycle specialists.