Medically Unnecessary Inpatient Hospitalizations

Submitted by Matthew.Gregor… on Mon, 11/04/2019 - 07:41
Medically Unnecessary Inpatient Hospitalizations

When patients with known diagnoses enter a hospital for a specific minor surgical procedure or other treatment that is expected to keep them in the hospital for only a few hours (less than 24), they are considered outpatients for coverage purposes regardless of the hour they came to the hospital, whether they used a bed, and whether they remained in the hospital past midnight.

Refer to the Medicare Benefit Policy Manual, Chapter 1, Section 10 (PDF), and the Medicare Quarterly Provider Compliance Newsletter (PDF)  [Volume 3, Issue 3] for more information.