INPATIENT/OBSERVATION REVIEW

YPRO consultants review inpatient/observation records for appropriate ICD-9-CM coding assignment, medical necessity, transfer and discharge criteria. Appropriate bed assignment can directly impact the revenue facilities are reimbursed. One financial impact is to determine if the patient met medical necessity for admission and if resources were utilized appropriately. Another financial impact is to determine if the patient was transferred timely or was discharged appropriately. Facilities can experience a significant financial impact by not monitoring medically necessity upon admission status, in-appropriate transfers to swingbed or other acute care facilities and untimely discharges.

PURPOSE
The purpose of an Inpatient Review is to determine that inpatient hospital care was medically necessary, reasonable, and appropriate for the diagnosis and condition of the patient at any time during the stay. The patient must demonstrate signs and/or symptoms severe enough to warrant the need for medical care and must receive services of such intensity that they can be furnished safely and effectively only on an inpatient basis. Inpatient care rather than outpatient care may be determined necessary only if the patient's medical condition, safety or health would be significantly and directly threatened if care were provided in a less intensive setting.

METHODOLOGY
An Inpatient Review consists of reviewing Inpatient, Observations & Observation changed to Inpatient medical records. Each record is validated for accurate ICD-9-CM coding, appropriateness of admission, principal diagnosis related to severity of illness and intensity of service and medical necessity. A through review of ICD-9-CM coding and documentation is conducted as well. Findings are discussed with the Coding staff & UR/Case Management at the end of the review and recommendations are made. CE's are provided to the HIM Staff & UR/Case Management. The client is provided with a written summary of the review detailing the findings and recommendations.

BENEFITS
· Reduce denials
· Improve reimbursement
· Improve quality ratings/rankings
· Improve adherenceto compliance regulations
· Access to the latest regulatory information

Request More Information