Inpatient, Outpatient and Condition Code 44

Event Information
Product Format
Prerecorded Event
90 Minutes
Product Description

Clear Up Inpatient vs Outpatient Confusion and Use Condition Code 44 Correctly

When a patient is initially admitted as an inpatient, a determination may be made that the status should have been outpatient observation. Condition Code 44 was developed to address this type of situation, but there has been significant controversy concerning the use of Condition Code 44 and Part A to Part B billing.

Our expert Duane C. Abbey, in this advanced workshop, will discuss the confusion related to when a patient is an inpatient versus being an outpatient. The conference will address the RAC (Recovery Audit Contractor) concerns about inpatient status, observation and possible recoupments, Condition code 44, recent Federal Register discussions from CMS as well as the O’Connor Hospital appeal.

Register for this power-packed event and get answers to these questions:

  • Just What Constitutes and Inpatient Admission?
  • Why Do The RACs Concentrate on Short-Stay Admissions?
  • Just What Is Observation?
  • How Should Condition Code 44 Be Used?
  • Is There A Difference Between Medicare and Private Payers?
  • What Are The Compliance Issues Surrounding Condition Code 44?
  • How Does the Utilization Review Committee Become Involved in Condition Code 44 Situations?
  • How Do The RACs Become Involved With Observation and Condition Code 44?
  • What Is the O’Connor Hospital Ruling?
  • How Has CMS Reacted To the O’Connor Hospital Ruling?
  • How Does CMS Want To Address the Part A to Part B billing process?
  • What is payment documentation?

Here are a few topics covered in the session:

  • Discuss the issue of what constitutes an inpatient admission.
  • Briefly review inpatient admission criteria and CMS’s refusal to adopt specific guidelines.
  • Review the observation concept and payment for observation services.
  • Review RAC activities relative to the inpatient versus outpatient issue.
  • Review various Medicare rules and regulations concerning observation services including counting hours, Condition Code 44, and documentation requirements.
  • Appreciate how the Medicare interpretation of Condition Code 44 is different from private payer interpretations and usage.
  • Review the O’Connor Hospital Ruling from the Medicare Appeals Council.
  • Understand how CMS has reacted to the O’Connor Hospital Ruling and similar appeals.
  • Appreciate how CMS wants to address Part A to Part B billing as discussed in Federal Register entries.
  • Understand how to handle short-stay inpatient admissions that should have been observation.
  • Discuss the Utilization Review Committee involvement in observation services including the UR Physicians.
  • Know the importance of maintaining an observation log for each observation
  • Coding for observation services
  • Find out when you can change the status of a patient from inpatient to outpatient
  • Know the NUBC definition of condition code 44
  • Find out why RACs Concentrate on short-stay admissions
  • What is payment documentation
  • Learn through case studies and examples

Who should attend? Outpatient Nursing Staff, Medical/Surgical Nursing Staff, Nurse Managers, ED Nursing Staff, Utilization Review Personnel, Quality Assurance Personnel, Quality Assurance Personnel, Physicians, Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, and Other Interested

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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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