Facing the issue of admitting privileges.
Recently I became the physician advisor for a critical access hospital, Cameron Memorial Community Memorial Hospital in Angola, Ind. It was a huge step for them and one that was met with total anticipation and acceptance.
This hospital has the mentality of a mid-size hospital in a small footprint. They did, however, have an outsourced physician advisor for a second-level review process from a well-known corporation. Realizing that a physician advisor can offer so much more than case reviews, the executive and leadership staff gave full support to me and hired me as their own.
During each edition of Talk Ten Tuesdays, I have a segment in which I share a journal entry on my experiences in this new venture as a physician advisor. So, for this journal entry I want to focus on just one of the many tasks that I am undertaking. For background purposes and methodology only, I wanted to share that my start was exactly the same process that I have done numerous times for my consulting projects. It is important to keep in mind that some of the projects can become cases studies and the topics are not limited to just this hospital.
For variable reasons and also when the Two-midnight rule came into existence, many hospital facilities gave admitting privileges to their ED physicians. Some of the main reasons given were the following:
This has and does raise quite a debate that has gone on for several years since the institution of this practice. The American College of Emergency physicians has a definite policy regarding this topic:
| Therefore, ACEP endorses the following principles: Patients are best served when there is a clear delineation of which clinician has patient care responsibility. The best practice for patients admitted through the ED is to have the admitting physician (or designee) evaluate and write admitting orders for ED patients requiring hospitalization at the time of admission or as soon as possible thereafter. The admitting physician (or designee) is responsible for ongoing care of the patient after accepting responsibility for the patient’s care whether verbally, by policy, or by writing admission orders, regardless of the patient’s physical location within the hospital. The emergency clinician is responsible for ongoing care of the patient only while the patient is physically present in the ED and under his/her exclusive care. |
A link is provided below for a survey to delineate more about how prevalent is the practice of ED physicians having admitting privileges. It is not designed to influence how facilities handle this issue but provide information on the extent of this practice and maybe some of the consequences thereof. I am asking you to take 10 minutes of your valuable time to contribute to this survey and the results will be presented in next week’s “Journaling John MD.”
https://www.smartsurvey.co.uk/s/EDPhysicianAdmittingPrivileges/
Programming Note: Listen to Dr. John Zelem every Tuesday on Talk Ten Tuesdays, 10 Eastern.
We’ve trained ourselves to audit documentation, audit codes, audit teams – but now we need to ensure we have added something else to the list:
The Unified Program Integrity Contractors (UPICs) were developed to ensure the integrity of Medicare and Medicaid by identifying and recovering improper payments. Established to streamline
Please log in to your account to comment on this article.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
