Medical Necessity Documentation I

Download this tip

Did you know? All health insurance carriers are increasingly scrutinizing your belief that the patient in front of you really requires inpatient admission to your hospital

• Please DO NOT admit someone simply because “they can’t walk”
• Please DO NOT admit someone for “s/p fall”
• Please DO NOT admit someone for “nursing home placement”
• Please DO NOT admit someone in order to “rule out” a particular diagnosis
• Please DO NOT admit someone because “the family can no longer take care of them”

*Patients must have a legitimate medical reason (i.e. a specific diagnosis) that can only be treated in the acute care setting in order to qualify for hospital admission reimbursement.

Other Important Medical Necessity Considerations:
• A patient’s chronological age is NOT part of any recognized admission criteria
• A patient’s medical condition should NEVER be described as “stable” at the time of admission
• At the time of admission, please Do Not state that you will “observe the patient” or that you will “observe overnight” or that “I expect the patient will go home in the morning”

*Note: It is almost impossible to justify hospital admission if all of the patient’s vital signs and all of their lab results are within normal limits.

Download the complete tip, Medical Necessity Documentation I.