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Regulations are fun
Hospitals provide Hospital-Issued Notices of Noncoverage (HINNs) to beneficiaries prior to admission, at admission, or at any point during an inpatient stay if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered because it is:
•Not medically necessary;
•Not delivered in the most appropriate setting; or
•Is custodial in nature
2 Midnight Rule
The Two-Midnight rule stated that:
- Inpatient admissions will generally be payable under Part A if the admitting practitioner expected the patient to require a hospital stay that crossed two midnights and the medical record supports that reasonable expectation.
- Medicare Part A payment is generally not appropriate for hospital stays not expected to span at least two midnights.
The 340B Drug Discount Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices.
Inpatient Only Surgery
"Inpatient only" services are generally, but not always, surgical services that require inpatient care because of the nature of the procedure, the typical underlying physical condition of patients who require the service, or the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged.
Physician Advisor is a physician with experience in clinical, regulatory and management processes who acts as a liaison between the hospital administration, clinical staff, and support personnel to ensure compliance in terms of documentation, bedding status, appeals and denials and cost utilization.
The Aerolib Learning Management System is an On-demand E-learning system for Clinical and Regulatory education for Physicians, Physician Advisors, Case managers, Utilization Review personnel and Hospital Administration that is based on Aerolib`s successful education methodology of Disease Specific Documentation Improvement.
The MOON is a standardized notice to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
UR and CM personnel
Clinical documentation improvement (CDI) is the recognized process of improving healthcare records to ensure improved patient outcomes, data quality and accurate reimbursement.