Observation Hours >48

lrdelin

1. Is anyone billing observation hours greater than 48 hours as a covered for all payers or does anyone bill non-covered observation hours after 48 hours? I seem to see more patients being in observation over 48 hours.
2. How are you handling a patient where the payer says they will not pay for inpatient but will pay for observation when the patient has been in house for 7 days and has been discharged? Do you bill for observation for all 7 days (168 hours) as covered or non-covered after 48?

RHirsch

7 days???? Yikes!

There is an NCCI edit at 72 so that might be an issue.

But if your contract is percent of charges, bill them all and take the money and run! If the payment is a fixed Observation payment a la CMS, then it's to your contracting folks to address this. Not that criteria are the final determinant, but MCG and InterQual both say Observation is a limited time, not indefinite.

Now I will add that many people use Observation for billing patients who are sitting around without medical necessity, waiting for family or for an open bed in long term care or who just have nowhere to go. That's not medical necessity and could result in a patient staying as outpatient for over 48-72 hours.