“Finally Friday!” To Part B, or Not to Part B: Should you rebill Part B Inpatient?

FRIDAY November 18, 2016:

“To Part B, or Not to Part B?
Is that really the question?”

or how do you decide
how to bill short stay strokes?

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THIS WEEK, we have invited several working Physician Advisors to join us on the show to go over some suggestions that came up this week on the rac-relief Google Group listserv, and it was a great discussion, with lots of comments. So we are reviewing some of it and discussing it in what we hope is a helpful manner…

The original question [posted by a Physician Advisor from a hospital in Colorado] involved a patient admitted as Inpatient for Stroke, not TIA, but then discharged before a 2nd midnight is crossed, since the pt was improving and appeared stable.

  • Patient arrives with + neuro findings. Mild/Non-disabling. Facial droop, some slurred speech, maybe pronator drift in Upper Ext.
  • Sx have been either been present for > 24 hours already, or perhaps earlier today but always stable or improving.
  • No active comorbid conditions requiring significant additional evaluation or management.
  • Initial CT in ED negative.
  • Admitted as Inpatient by Hospitalist. Dx Stroke vs. TIA. Plan of care is usual Stroke protocol without TPA. Neurochecks, Tele, MRI, CTA or Carotid Duplex, Echo.
    Perhaps Neurology Consultation.
  • MRI later in the afternoon or the next AM => + for acute or subacute ischemic CVA. Usually small size but present.
  • UM nurses run screening criteria. + Imaging meets MCG and InterQual and they approve IP stay.
  • Subsequent studies reassuring, patient is not worsened the next AM. Neurologist adds Plavix, and patient discharges prior to the second midnight of care.

The question asked was whether to leave the bill as IP or self-deny and rebill as Part B IP.

I’ll be posting more about who will be joining us, but I’ve already confirmed that Dr. Steven Meyerson will be on with us, so be sure to come listen in!

So… join us as we will be discussing these points:

  • HOW is risk as a factor in LOS expectations;
  • HOW risk maybe be seen differently based upon a Dx, especially one without presenting complications/comorbidities;
  • HOW documentation must support the clinician’s thought process used in decisions of treatment & plan of care (including various “scores”);
  • WHAT is the legal risk of an aggressive attitude in billing whereby patients are admitted by proxy based upon the comparatively (and deceptively false) low cost of denials (which takes into account that only 2% of all claims are reviewed, but fails to factor in the debilitating cost of extrapolation, FCA fines, et al).

So join us, share your own insights and bring your questions for us!

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