“Finally Friday!” OBS, 2-Midnights, and Criteria: How Do Guidelines Help?

This session was recorded on Friday, November 15, 2013.

How Guidelines Are Still Important - Now More Than Ever!

How Guidelines Are Still Important – Now More Than Ever!

OBS, 2-Midnights, and Criteria:  How Do Guidelines Help?

We Hear Directly from MCG (Milliman Care Guidelines)

This week, we wanted to look at how screening criteria have or have not been affected by all the changes providers must endure under the 2014 IPPS Final Rule, CMS-1599F. There has been discussion on past weeks of what the role of criteria/guidelines will be, now that time has become such a factor, when considering the appropriateness of patient status and subsequent reimbursement by payors. Truly, it remains to be seen how the 2-Midnight Rule & Certification will affect hospital net operating margins, when they are finally fair game for all CMS reviewing entities, including post-payment review by Recovery Audit Contractors (RACs). So, Sharon and I invited Milliman Care Guidelines to come on the show and discuss what they see as their role in support of providers living under the new rules, particularly the 2-Midnight Rule.

MCG, formerly Milliman Care Guidelines, has published a white paper on the Two-Midnight Provision, and it is available below, by permission.

Listen while Bill Rifkin, MD, FACP, FHM and Managing Editor for MCG briefs us all on some important points about the use of guidelines, including how reviewers don’t want to debate over whether someone with pulmonary edema needs care, but rather how bad it was, how did you determine this, and what did you try and what happened when you did.

You can also hear him explain:

  • The Five Keys to successful use of guidelines;
  • How the new IPPS Final Rule affects guidelines;
  • How guidelines can HELP with OBS, medical necessity, and the new admission requirements.

Check below for the Handouts!




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