OPPS Comments Focus on Observation Status
The New Jersey Hospital Association noted that clear guidance from CMS is necessary so hospitals and physicians "have more certainty that they are making the right decisions" so the "risk of audits and denials is minimized."
It also stated that "the treating physician's judgment, which takes into consideration both the patient's conditions and other risk factors, should be the primary determining factor for inpatient admission decisions, not external rules and criteria."
The American Hospital Association pointed the finger at recovery audit contractors (RAC) and Medicare administrative contractors (MACs), which it contends have started to "inappropriately second guess physician judgment, declaring that some patients who were admitted should not have been." It adds that "patients who thought they were admitted are surprised to learn that they were actually receiving outpatient services."
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