Article
I wanted to share a significant change on how CMS is approaching the admission order. The notice below is for CERT auditors only it states "CERT auditors are now required to deny inpatient hospital stays as not medically necessary when the record does not include a formal physician’s order to admit to inpatient." YPRO has noted an increase in admission denials because of admission order issues from other CMS auditors. Many hospitals have issues with admission orders and now is a good time to correct the problems before you start to see an increase in admission denials.
Here are example admission order issues:
1. No admission order or no signed admission order.
2. Admission order signed by ER physician not physician responsible for a patient's care at the hospital.
3. No justification for the admission - diagnosis and co-morbidities need to show the medical necessity for the admission.
4. No patient status indicated - CMS clarified that this is considered an inpatient admission but physician may be thinking Observation. If patient does not meet medical necessity you will face a denial
5. No date or time can cause a denial primarily for inpatients admitted from observation. The observation patient must meet inpatient criteria AT THE TIME OF THE PHYSICIANS ORDER. Without a time/date an auditor may look at when the order is noted on the floor which may be some time after the order was written you can end up with a denial
6. Issues with the admission order form(s) - a review of your current admission orders is a good idea. The admission check boxes should be “inpatient admission” and “refer for observation”. Justification – allow at least 2 full lines (from #3 above). Do not get the form too crowded or the print too small as this can cause errors. Also see #7 below. There are more issues this is just brief list.
7. Do not accept admission orders written on anything other than the hospitals’ formal admission order form. If a physician writes an order to admit on his prescription pad – transcribe the order to the hospital admission order form. Call the physician if necessary information is missing and have the physician sign the hospital admission order within 24 hrs. The hospital admission order form should have a place for the person taking the verbal order to provide printed name, signature, credentials, title, date and time. This can even be used by ER physicians after talking to the admitting physician.
Terry Myers
President, YPRO Corporation
Link to article
http://www.medicarenhic.com/providers/articles/CERTPhyOrdersInp.pdf