Observation Inpatient

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					Observation/Inpatient


    Unlock The Mystery
         What does it all mean?
 In the early 90s guidelines for insurance and Medicare
  payments to hospitals began to go through some drastic
  changes.
 Stricter regulations were introduced that defined diagnosis
  driven billing.
 Patients hospitalized with certain diagnosis's had to be
  discharged within 24 hours. The hospital then receives the
  payment indicated for that diagnosis.
 Thus, the word “observation” took on a new light and the
  question was being asked in hospitals around the country, “Is
  this patient Observation or Inpatient?”.
Patients being admitted to the hospital must now have an “admission status” of
“Inpatient” or “Observation”. They have to be registered in the computer as an
(O) Observation or (I) Inpatient and must have a doctor’s order for that status.
They also must have a doctor’s order for any changes in the status.

Patients admitted with diagnosis's that can be treated and released within 24
hours are admitted as observation.

Patients admitted with diagnosis’s that require a longer treatment plan are
admitted as inpatient.

Some patients are admitted as observation but due to complications or
changes in their medical condition cannot be discharged after 24 hours and
must be changed to inpatient. There must be a doctor’s orders for “Upgrade to
Inpatient”.

The hospital is paid a set sum for the observation portion of the admission and
then paid for the inpatient portion of the admission providing that all guidelines
are followed correctly.
     Patients Admitted From the ED
                               The patient is registered in the computer in a
                                    unit called DEH (HEH in Hasbro), a
                               “cyberspace” holding unit where the patient’s
                               information and orders will stay until they are
                                     transferred to their in-house bed.

                              The Emergency Department doctor will let the
                                 registrar know whether the patient will be
                                   registered as inpatient or observation.
ED Doctor
                              When the admission orders are entered, the
                                physician may agree or not with the admit
                                     status ordered by the Emergency
                                 Department doctor. The admission orders
                                  are entered by the physician that will be
                                    caring for the patient once they are
                               transferred to the unit. The doctor will enter
            In-house Doctor          “Admit as Inpatient” or “Assign as
                                                Observation”.
             The Patient Arrives
                   Once the patient arrives on the inpatient unit
                      the Unit Secretary begins to process the
                      patient’s orders.
                     The secretary compares how the patient is
                      registered in the computer to the doctor’s
                      order.
                     Is the registration an I or O?
Unit Secretary
                     Is the doctor’s order, Admit as Inpatient or
 Unit Secretary       Assign as Observation?
                     If they are both the same the U.S will not need
                      to do anything. If they are not the same he/she
                      will need to take the next step.
             Sending a Notification
                                    The Unit Secretary sends a notification to
                                     the Business Office to change the status
                                     via the computer by going to (1) ADT
                                     and picking one of the two notifications.
                                             (42) Inpt to Obs Notification
Unit Secretary                               (44) Obs to Inpt Notification
                                    The status must be changed to match the
                                     doctor’s order.
                                    Example: Registration (I)
                                                Dr’s Order (O)
                                   US sends Inpt to Obs Notification.


                 Business Office
The Status Is Changed
         After receiving the notification the
          Business Office will change the status to
          Obs or Inpt as indicated on the
          notification.
         The notification prints 2 copies-one to the
          Business Office and one on the unit.
         File the one you receive on your printer in
          the chart immediately after the
          demographic sheet.
         It may take a little while before you see
          the status change in the computer. The US
          is only sending a notification, the Business
          Office makes the actual change.
Upgrade to Inpatient
           An observation patient that
            cannot go home within 24 hours
            must be upgraded to inpatient.
           The doctor will place an order
            for “Upgrade to Inpatient”.
           When the US receives the order,
            he/she must send an
            Observation to Inpatient
            Notification.
           The Business Office will change
            the patient to Inpatient.
As you have learned, patients admitted as observation can be upgraded to
inpatient. This actually creates 2 accounts when the billing is completed. The
observation portion and the inpatient portion.
However, patients admitted as inpatient can only be changed to observation dating
and timing back to admission. So in other words, the observation portion of the
account must be first.
A patient’s status can only be changed once in 24 hours.
Example: patient is admitted as inpatient
          patient arrives on the unit and the MD enters “Assign as Observation”.
          the Unit Secretary sends notification “Inpatient to Observation” and the
           Business changes the patient to (O) Observation.
           later that day doctor enters “Admit as Inpatient”.
           the US sends the “Observation to Inpatient” Notification.
           the Business Office will not be able to change the status until after
           midnight. But the US must still send the notification so the Business
           Office will know to change the status after midnight.
Please register        1                         2
                                                     We’ll have you in
  Mr. Pain as                                        your room soon
 Observation.                                           Mr. Pain.



                                                     I will send an Obs
    I entered an           3      INPATIENT      4          to Inpt
      “Admit as                OR OBSERVATION?           notification
 Inpatient” order                                       because he is
   for Mr. Pain.                                        registered as
                                                        Observation.


I received the Obs                                   Hmm…it seems
                           5                     6
to Inpt notification                                 as if all changes
 and I will change                                      were made
    Mr. Pain to                                       correctly. The
     Inpatient.                                        hospital will
                                                       receive full
                                                     payment for this
                                                            case.
Please register    1                                2
                                                                  We’ll have you in
  Mr. Pain as                                                     your room soon
 Observation.                                                        Mr. Pain.




   I entered an        3      INPATIENT             4
                                                                  OK, I don’t need
     “Admit as             OR OBSERVATION?                         to do anything
Inpatient” order                                                  with the status.
  for Mr. Pain.



                             5
                                     Hmm…it seems as if all
                                   changes were not addressed
                                  correctly. The hospital could
                                   loose a lot of money on
                                        this account!
         Observation Start Date/Time
Insurance providers look for several pieces of information when
 approving or denying observation accounts for payment. These
 are the 2 pieces they look for when reviewing the admission
 portion:
 1. The first indication of care being rendered once the patient has
    arrived on the unit. This would be the time the first set of vital
    signs taken and date/time documented by RN/CNA.
 2. The “Observation Start Date/Time” entered by the Unit
    Secretary when the transfer function was performed.
 These 2 times must coincide or total or partial payment
    can be denied.
       How will RN/CNA/US make sure these times match?
                 US                                      RN/CNA
 Notify RN/CNA that the patient is
  observation.                               Ask the US if the patient is
 Before transferring the patient into        observation.
  your census you must know the
  time of the first set of vital signs
  as documented on the Flow
  Sheet.                                     Notify US of the time
  If you do not get that information from     documented on the Flow Sheet
  the RN/C.N.A. then you must                 for the first set of vital signs.
  obtain it before you can transfer
  the patient.
 Transfer patient into your census. On
  the transfer screen, enter the
  date/time of the first vital signs, as
  documented on the Flow Sheet, in
  the “Transfer Date/Time and the
  “Start Obs Date/Time” field.
       Observation End Care Date/Time
Insurance providers look for several pieces of information when
 approving or denying observation accounts for payment. These
 are the 2 pieces they look for when they are reviewing the
 discharge portion:
1. The last indication of care being rendered once the patient is
   ordered to be discharged. This would be the date/time the nurse
   reviews the discharge instructions with the patient.
2. The date/time the Unit Secretary entered in the “End Care
   Date/Time” field when performing the discharge function.
These 2 times must coincide or total or partial payment
   can be denied.
           How will RN/US make sure these times match?
                    US                                               RN
                                                 Enters or writes the time discharge
 Before performing the discharge function,
                                                  instructions are reviewed with the
  locate the CoC/Patient Instruction              patient/family on the bottom of page 2 of
  sheet(s).                                       the CoC/Patient Instruction Sheet.
                                                 If CoC/Patient Instructions are being
 Enter the exact date/time written by the
  RN on the bottom of page 2 of the               printed immediately before giving the
  CoC/Patient Instructions into the “Obs          instructions, the date/time can be entered
  End Care Date/Time” fields when                 on the electronic CoC form.
  performing the discharge function.             If the CoC/Patient Instructions have been
 If date/time is not documented, inform the
                                                  completed electronically but instructions
  RN that the date/time must be                   are not going to be reviewed yet, print the
  documented on the CoC/Patient                   CoC/Patient Instructions and write the
  Instruction sheet so that you can enter the     time that instructions are reviewed.
  exact same time

				
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posted:10/30/2011
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