Are Your Hospital's Standing Physician Order Forms Contributing to Incorrect Assignment of Patient Status on Admission?

(PYA Alert dated April 18, 2007)

The CMS Intermediary Manual Part 3, Chapter II, section 3112.8, requires the physician’s admission order to clearly state the level of care the patient requires, e.g., “admission to inpatient status” or “admission to observation status”. When there are ambiguous or missing level of care options on the Standing Physician Order forms this may contribute to the inappropriate level of care assignments selection by physicians at the time of hospital admission. Improper level of care assignment can lead to improper billing. And with payment for observation versus inpatient services once again on the OIG’s 2007 Work Plan, this can also increase your hospital’s compliance risk.

Has your organization conducted a recent comprehensive review of its pre-printed physician order sets to examine for potential compliance risks related to observation versus inpatient assignment? The standardization of standing physician order sets, and education to the appropriate stakeholders involved in the assignment of patient status, may assist in reducing the number of incorrect level of care assignments and billing errors. In addition, the implementation of specific processes for proper application of Condition Code 44 can also be an innovative strategy to reduce hospital payment errors.

PYA’s team of Clinical Compliance and Reimbursement professionals can assist in assessing your compliance and reimbursement risk, identify process improvement opportunities, and educate your staff to ensure compliance within your organization.

If you would like more information, please contact Lorraine Larrance at (800) 270-9629.

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

back to PYA Alerts