Inpatient / Observation Determinations
Patient presentations to the hospital are real challenges for all involved. Many of these patient visits can be evaluated and treated in the ER with disposition back to the home setting. However, some of the ER visits and direct admissions from the physician's office need to be kept in the hospital setting. There is a big difference in the level of services provided to these patients and the duration of these hospital stays. This translates into a massive difference in the cost of the care provided.
A well informed and highly functioning case management team successfully supporting inpatient admission requests to payers can be the single biggest difference between hospital profit or loss.
Understanding the available complex admission criteria and how to apply them is crucial. Knowing that all patients will not fall into specific diagnosis criteria means that you often times need more than standard guidelines to make a convincing argument to payers regarding the level of reimbursement.
Having a background in caring for acute care patients and years of experience in making concurrent inpatient versus observation decisions means that Cadenza Health is well positioned to be your partner in this challenging arena of our health system.