Observation Services: How Case Managers Can Lead the Way

Creating an Action Plan for Proper Documentation, Billing and Compliance

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The role of the acute care case manager is expanding, and one place where frontline case managers can make a deep impact is the area of patient status – and the confusing subject of observation services.

When it comes to observation, reimbursement, compliance and patient satisfaction are three of the biggest issues at stake – and all three are linked to the financial viability of acute care facilities. While the observation services designation is driven by a physician, the surrounding case management staff has the opportunity to ensure that documentation is correct, that services are appropriate and that the patient is aware of their situation and satisfied with their care.

Join the Case In Point Webinar series as a faculty of case management leaders identify the leading strategies, teams, processes and programs created to ensure compliance and drive optimal reimbursement from payers, all while maintaining tools and tips for patient satisfaction.
 

About the Webinar

With inpatient admissions criteria more stringent than ever, hospitals must fully understand the opportunities available when applying designations to patients. Implementing best practices in documentation, billing, medical necessity and pre-access plans will make sure hospitals are securing reimbursement — and covering their history in a safe way to ward against federal auditing bodies.

For what seems like a simple designation, observation status is proving to be a complicated and potentially costly aspect of Medicare admissions. Recently, one hospital on the west coast was forced to recompense the federal government to the tune of $2.2 million because of an observation vs. inpatient discrepancy.

“Observation status is an administrative classification of patients seen in hospital emergency rooms or outpatient clinics who have unstable or uncertain conditions potentially serious enough to warrant close observation, but usually not so serious to warrant admission to the hospital,” describes the Agency for Healthcare Research and Quality (AHRQ).

Yet despite these defining terms, observation status is far from clear cut. “The designation of ‘observation status’ patients by hospitals is not well understood and has the potential to distort traditional measures of inpatient hospital utilization,” concludes AHRQ.

This Case In Point webinar is aimed at giving healthcare practitioners, particularly case management teams, in facilities the knowledge and know-how they need to adhere to appropriate guidelines, secure proper documentation and “observation history,” and install proven programs that have show to avoid costly audits and maximize reimbursement. 
 

Program Objectives

• Define observation services and the surrounding issues.
• Identify the key areas where case managers can implement quality-driven programs.
• Describe the vital area of documentation, and the strategies to secure it.
• Explore best practices aimed at improving patient satisfaction.
• Identify how emergency departments can improve their observation workflow.

Our Webinar Will Answer These Questions

• What is the definition of observation services?
• Who is involved in observation designation in optimal situations?
• How can case managers take leadership positions on this issue?
• What tools and strategies can improve compliance?
• What tactics have proven to boost reimbursement capability?
• How can a comprehensive action plan boost the health of my facility?
• When should a case manager start to be involved in observation designation?
• What do best-practice programs involve on the team?
• What is the full potential of a thorough observation program?
• How can I improve patient satisfaction at my facility?

Faculty

Deirdre Hodges, RN

Harry Kallipolitis, RN, BSN
 

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