Symptoms Aren’t Enough for Admission; Leaving AMA Causes Confusion

As long as physicians explain why inpatients recovered faster than expected and therefore were discharged before the second midnight, their Medicare Part A claims have a good chance of surviving an audit under the two-midnight rule. But it’s not good enough for physicians to state only that patients are safe for discharge earlier than anticipated. The same goes for simply documenting a symptom without putting it in context. Auditors tend to consider symptoms in isolation as appropriate for observation services.

These insights have emerged from reviews of short hospital stays by Livanta and KEPRO, two quality improvement organizations (QIOs), says Nancy Perilstein, senior manager with Deloitte Advisory .

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