2018 Observation Services: Proper Coding, Billing and Documentation to Maximize Reimbursement

Event Information
Product Format
Prerecorded Event
Conference Date
Tue, May 22, 2018
90 minutes
Product Description

Comply with Coding, Billing, and Documentation Requirements for Observation Services

Join this session, where healthcare management consultant Duane C. Abbey, Ph.D., CFP will cover the documentation requirements for observation services. Duane will focus on distinguishing observation services from inpatient admissions. This session will cover physician documentation along with nursing and clinical documentation. Further, the session will help you distinguish payment documentation from clinical documentation.  

The session will discuss charge capture and proper billing issues relative to the overall documentation process. Duane will address auditing standards so that you can access both the documentation and documentation process relative to external audits such as the RACs. The session will also discuss special situations such as the over 2-midnight rule and the Medicare Outpatient Observation Notice (MOON) form, relative to documentation.

Session Objectives

This session will help you learn:

  • The concept of observation and associated services
  • How physicians should document to justify observation services
  • What physicians should document at the time the patient is discharged from observation services
  • How documentation must support the coding and billing process
  • To distinguish payment documentation from clinical documentation
  • How observation differs from inpatient admissions
  • The medical decision making relative to the over 2-midnights rule
  • To appreciate the need to track hours of observation including intervening services
  • How an observation log can assist in reviewing documentation and appropriateness of coding and billing
  • To appreciate the need to fastidiously address use of the MOON form
  • The use of standard observation protocols or care paths
  • To appreciate the documentation requirements that will satisfy auditor requirements
  • To appreciate why Medicare is so concerned about post-surgery observation
  • To realize how Medicare reimbursement is affected by a procedure performed after observation
  • To understand how private payers view and use observation services

Session Highlights

This session will discuss:

  • What is observation
  • How is observation different from an inpatient admission
  • Do patients understand the difference
  • How should a physician document to justify observation services
  • Is there a difference between payment documentation and clinical documentation
  • What should a physician document at discharge from observation
  • How can an observation log assist in justifying observation
  • How does the use of Condition Code 44 affect the documentation
  • How should nursing staff and other clinical staff document to support coding and billing for observation
  • Why is it important to carefully track time and interrupted observation
  • What kind of policies and procedures should be in place to effectively document, code and bill for observation
  • What is this MOON form and how should it be handled
  • Why is post-surgical observation such an issue
  • Is observation followed by a procedure a problem
  • How do auditors view observation services
  • How do private payers view observation

Session Agenda

This session will cover:

  • Observation services
    • Types and levels of services
    • Organization and provision of observation services
      • Dedicated units
      • Medical/surgical floor beds
    • Coding, billing, and payment for observation
    • Distinguishing inpatient from outpatient observation
    • Physician supervision
  • Documentation for observation
    • Physician documentation
      • Justifying observation services
      • Interim visits
      • Discharge from observation summary
    • Over 2-midnights rule
    • Use and advantages for an observation log
    • Nursing and clinical documentation
    • Payment documentation versus clinical documentation
    • Care paths for observation services
      • Types of care paths
      • Documentation sufficiency
    • Physician supervision
  • MOON Form
    • Policies and procedures – Timing, presenting, explaining
    • Documentation for observation vs. inpatient admission
    • Signature requirements
    • Personnel requirements
  • Auditing observation services
    • Developing audit guidelines
    • Preparing the documentation package for observation
    • Conducting mock audits
  • Private payer consideration for observation
    • Changing inpatient to observation
    • Documenting requests from private payers to change inpatient to observation
  • Payment for observation services
    • Physician payment
    • OPPS payment – Comprehensive APC 8011
    • Private payer payment
  • Special considerations
    • RAC audits
    • Coordination with ER services
    • Coordination with inpatient admissions
  • Sources for further information

Who Should Attend

  • Outpatient nursing staff
  • Medical/surgical nursing staff
  • Nurse managers
  • ED nursing staff
  • Utilization review personnel
  • Quality assurance personnel
  • Physicians
  • Non-physician practitioners
  • Coding personnel
  • Billing and claims transaction personnel
  • Chargemaster coordinators
  • Financial analysts
  • Compliance personnel
  • Other interested personnel

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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