• Dr. Burke looked at the InterQual discharge criteria. InterQual recommends 48 hours. Therefore, the key is that whether the criteria meet the InterQual criteria or not. However, we don’t know the cost implication for moving patients to inpatient status or lower level of care.
• If we move patients to inpatient, the medical directors still need to review the case.
• Questions: o What are the criteria to make that push one way or another? o Assuming the patients is in observation stays and not responding to the treatments, what is the process? Will the patient remain in the observation stay status? 12-09-15 | Dr. Belgrave mentioned the current process where he typically would send the patient as in-patient care (although the case may not …show more content…
12-09-15 | Jane said that this would require policy change and notify the providers. o What is the overall philosophy for observation stays? o Will need these save money or not? Hypothetically, if we move 75% of observation stays to inpatient status, is this a finical opportunity. In what area, can we tighten the cost and setup a process? o How do we need to help the providers decides observations or inpatient status? Can we deny the claim? o Beth wants to know (before writing the policy) is it possible to review the admission status in timely manner? Health Integrated reviews the cases from the weekend retrospectively on Monday.
• 12-09-15 | MaryD said if the providers fail to provide the documents for medical necessity or not corporative or not following our process, we do not have obligation to pay.
• 12-09-15 | Beth said to focus on the observation days 24+ hours for commercial and 48+ for Medicaid and Medicare.
• 12-09-15 | Ellen said that HA currently review the cases when patients needs to move from observation stays to inpatient status.
• 12-09-15 | Zoe said that they have tried looking into the data while researching 1-2 days in patient. As they dig into the data, they hit the wall. We would need to reprice the
• If we move patients to inpatient, the medical directors still need to review the case.
• Questions: o What are the criteria to make that push one way or another? o Assuming the patients is in observation stays and not responding to the treatments, what is the process? Will the patient remain in the observation stay status? 12-09-15 | Dr. Belgrave mentioned the current process where he typically would send the patient as in-patient care (although the case may not …show more content…
12-09-15 | Jane said that this would require policy change and notify the providers. o What is the overall philosophy for observation stays? o Will need these save money or not? Hypothetically, if we move 75% of observation stays to inpatient status, is this a finical opportunity. In what area, can we tighten the cost and setup a process? o How do we need to help the providers decides observations or inpatient status? Can we deny the claim? o Beth wants to know (before writing the policy) is it possible to review the admission status in timely manner? Health Integrated reviews the cases from the weekend retrospectively on Monday.
• 12-09-15 | MaryD said if the providers fail to provide the documents for medical necessity or not corporative or not following our process, we do not have obligation to pay.
• 12-09-15 | Beth said to focus on the observation days 24+ hours for commercial and 48+ for Medicaid and Medicare.
• 12-09-15 | Ellen said that HA currently review the cases when patients needs to move from observation stays to inpatient status.
• 12-09-15 | Zoe said that they have tried looking into the data while researching 1-2 days in patient. As they dig into the data, they hit the wall. We would need to reprice the