Observation Services Training Handbook

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Observation Services Training Handbook (Pack of 5)

Product Code: OSTHB

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Observation Services Training Handbook (Packs of 5)

Reviewer: Janet L. Blondo, LCSW-C, MSW, CMAC, ACM, CCM, C-ASWCM, ACSW

Sold in packages of 5!

Observation services, from billing for observation to defining services, have been an ongoing pain point for hospitals. CMS recently compounded the challenge with the introduction of the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which requires hospitals to use the Medicare Outpatient Observation Notice (MOON) to notify patients of observation status both verbally and in writing.

The Observation Services Training Handbook, reviewed by respected case manager Janet L. Blondo, LCSW-C, MSW, CMAC, ACM, CCM, C-ASWCM, ACSW, goes past the definition of observation and discusses billing for observation, coverage of services, and counting of time. This handbook includes relevant information for physicians and is also useful for UR and case management, in addition to hospital staff members who need information about billing.

Table of Contents:

  • Medicare Definition of Observation Services
    • Medically Necessary Observation Services
    • Determining Whether Patients Qualify for Observation
    • The 2-Midnight Standard as It Relates to Observation
    • Clarifying Status Decisions 
  • Covered and Noncovered Observation
    • Medical Necessity, Severity of Illness, and Risk of Adversity
    • Nonreportable Services 
    • Extended Recovery
    • Authorizing Observation Services
    • Getting the Timing Right
  • Observation Notices 
    • The NOTICE Act and MOON
    • The Advance Beneficiary Notice
    • Important Message From Medicare
  • Billing for Observation
    • Calculating Observation Hours
    • Coding for Comprehensive Observation Services
    • Grasping the Complexity of Carve-Outs
    • Ensuring Proper Patient Status

Staff members who would benefit from this resource include:

Case managers, members of the utilization review staff, nurses, transition care nurses, discharge planners, discharge advocates, social workers, care coordinators, revenue cycle directors or managers, physician assistants, HIM directors/managers, compliance officers

About the Reviewer:

Janet L. Blondo, LCSW-C, MSW, CMAC, ACM, CCM, C-ASWCM, ACSW, is the manager of case management at Washington Adventist Hospital in Takoma Park, Maryland, where she works alongside nurse and social work case managers. Her career in case management and social work has included a wide range of experiences. She has held positions as director, assistant director, manager, and supervisor of case management; social work manager; clinical supervisor; emergency department case manager; medical social worker; and social work consultant. She is the author of HCPro’s Case Management Patient Communication Toolkit.

Blondo is passionate about case management and occasionally shares her knowledge through in-service educational programs. She has mentored those new to case management, served as a field instructor for both undergraduate and graduate social work students, and has educated nursing students interested in case management. She has a special affinity for creative problem solving and loves interdisciplinary collaboration.

A member of the American Case Management Association (ACMA), Blondo has served on the Board of the Maryland Chapter of ACMA, planning educational programs for its members. Her interests in advocacy and public policy were strengthened by joining other ACMA members on Capitol Hill to urge Congressional support for issues benefitting senior citizens. She has also testified before the Maryland General Assembly to successfully change a state law on a health issue that she brought to the attention of her state delegate. She serves as the Membership Chair of the Maryland ACMA.

Published: July 2016