Medicare and Medicare MA Inpatient denials - Change the patient status from IP to OP or leave?
I am trying to show the need for placing in observation first preventing these low case mix admissions that are denied since regulations below state when you have a patient admitted as IP but then is denied or self referred and bill part B you leave the patient status as ordered, Inpatient, in your MPI. My question is when you provide your facility monthly case mix index do you remove those cases from it or leave them?
CMS Rulings Department of Health
and Human Services
Centers for Medicare &
Ruling No.: CMS-1455-R Date: March 13, 2013
Patient Status Under the Ruling
For the Part B claims billed under this Ruling, the beneficiary's patient status remains inpatient as of
the time of inpatient admission and is not changed to outpatient, because the beneficiary was
formally admitted as an inpatient and there is no provision to change a beneficiary's status after
she/he is discharged from the hospital. The beneficiary is considered an outpatient for services
billed on the Part B outpatient claim, and is considered an inpatient for services billed on the Part B