Clinical Indicators for Inpatient Admission

As an ED or admitting provider, you often make quick decisions that have a significant impact on patient care, compliance, reimbursement, and hospital performance. 

One of those key calls? Determining whether a patient qualifies for inpatient care as determined by payor inpatient criteria. 

While every case is unique, there are specific clinical indicators that can help guide your decision and strengthen your documentation to minimize payor denials.

Demonstrate: 

• The severity of the patient’s symptoms, paint a picture through the review of systems, physical exam and assessment 

• The intensity, frequency and immediacy of required diagnostics, interventions or monitoring for each diagnosis within the plan of care 

• The risk of immediate adverse outcomes, using objective scoring criteria when available that are specific to the patient and their disease burden, if hospital care is not provided 

• Why the anticipated length of stay is at least two days 

We’ve put together a quick reference you can use in real time to help support inpatient status determinations and ensure your documentation supports them. 

The goal is simple: get patients in the right status from the start, keep your documentation bulletproof, and reduce headaches from avoidable denials later.