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The intersection of controversy and confusion is about to cause a pile up with providers, auditors  and the ALJ as a result of a news article that’s making the rounds entitled, “Two-Step Process for Clinical and Payment Decisions.” The article, from the National Government Services (NGS), says it has a two-step process to determine whether a patient should be admitted as an inpatient or be treated as an outpatient, allowing for a 48 hour period to make the decision.The article appears to be inconsistent with the Medicare Benefit Policy Manual, Chapter 1, Section, 10, establishing a 24 hour period as a benchmark.

Be sure to read the RACmonitor special bulletin by Steven J. Meyerson, MD, from Accretive Physician Advisory Services.

Note: This article has been rescinded and a follow up blog post has been written. Click here to read more…


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