Patient Status Pocket Cards for Physicians (Packs of 20)
Kimberly Anderwood Hoy Baker, JD, CPC
Ralph Wuebker, MD, MBA
Steven Greenspan, JD, LL.M
Purchase a pack for your physicians and case managers today!
This pocket card has been updated for 2016 and will help physicians determine the appropriateness of patient status based on expected length of stay through a series of guidelines and a decision tree chart based on Medicare regulations. Healthcare professionals can carry the laminated card in a lab coat pocket and refer to it when determining whether a patient should be admitted as inpatient, be placed in observation, or receive outpatient services.
Inpatient orders are a condition of Medicare payment and evolving requirements make determining patient status an ongoing challenge. The 2016 version includes updates to the patient status decision tree and guidelines, particularly for inpatient admissions of less than one midnight.
This pocket guide will help you do the following:
- Determine whether inpatient admission is appropriate for a patient
- Recognize requirements for hospital level of care
- Understand best practices for physician documentation
- Differentiate outpatient and observation guidelines
Table of Contents
- Recommended Medicare Admission Review Decision Tree
- Best practices for physician documentation
- Inpatient versus observation ordering guidelines
- Guidelines for surgical cases (does not apply to procedures on CMS inpatient-only list)
About the Authors
Kimberly A. Hoy Baker, JD, CPC, is the director of Medicare and compliance for HCPro, a division of BLR, in Danvers, Massachusetts. She is the lead instructor for HCPro’s Medicare Boot Camp—Hospital Version® and Medicare Boot Camp—Utilization Review Version, as well as an instructor for Medicare Boot Camp—Critical Access Hospital Version. Baker has experience conducting billing, compliance audits, and internal investigations.
Ralph Wuebker, MD, MBA, is chief medical officer for Executive Health Resources (EHR) in Newtown Square, Pennsylvania. Dr. Wuebker is board certified and continues to practice three to four days per month. He currently serves as a member of EHR’s physician education and audit team. He regularly visits EHR’s client hospitals to provide medical executives and staff members with ongoing education on a variety of topics, including Medicare and Medicaid compliance and regulations, medical necessity, Recovery Audit Contractors, utilization review, denials management, and length of stay.
Steven A. Greenspan, JD, LLM, is vice president of regulatory affairs at Executive Health Resources (EHR) in Newtown Square, Pennsylvania. He is responsible for overseeing regulatory research and hospital advocacy efforts, and collaborates closely with EHR’s appeals management teams to offer support on complex Medicare, Medicaid, and commercial appeals matters.
Published: March 2015