Course Provider
Learning Objectives
Define observation coverage, billing, coding, and payment rules
Discuss the appropriate application of ABNs for observation patients
State the new/revised inpatient order and certification requirements
Explain CMS 2-midnight rule benchmark
Describe the effect of hospital practice patterns on the 2-midnight presumption
Recognize exceptions to the 2-midnight benchmark
Describe the impact of LCD/NCD/CED criteria on inpatient coverage
State the rules for "inpatient-only" procedure billing and reimbursement
Describe the differences between condition codes 44 and W2
Use appropriate billing codes for full Part B payment for inpatient cases, including for "self-denials"