Author Description

Hospitals continue to struggle with applying CMS' patient status guidelines and 2-midnight rule requirements in real-world--and often high-pressure--situations. While CMS has issued clarifications to the 2-midnight rule and changes to ease inpatient order requirements, confusion still exists. This uncertainty can leave hospitals vulnerable to audits or lead to overly conservative patient status determinations, which can inappropriately delay reimbursement and even impact patients' financial responsibility. Utilization review (UR) committee members are tasked with conducting patient status reviews to help identify patients who may have been assigned to the incorrect status, but even these professionals may find it difficult to navigate Medicare regulations and provide support to physicians. The Patient Status Training Toolkit for Medicare Utilization Review, Second Edition, serves as a quick reference guide for UR committee members. The pocket card portion uses a flow chart and helpful tips to step through the process of verifying patient status determinations. If the committee member determines the patient's status must be changed, the pocket card provides guidance on next steps. The handbook portion of the toolkit provides clear, concise information on the applicable Medicare regulations, including provision of notices and billing rules, that can be used to help support UR committee members' patient status recommendations. In addition to an overview of regulatory requirements, the toolkit offers access to downloadable case studies and Medicare resources that will help guide committee members through real-world cases. This book will help readers: Ensure correct patient status determinations in fast-paced environments Quickly identify the necessary steps to change a patient's status Stay up to date on CMS' latest patient status guidelines, including the 2-midnight benchmark and recent changes to inpatient