1. Darlyn Victor, MD, EMBA, CPE

    Excellent post. We still deal with medical directors from different insurance companies, that no matter whether it meets per their guidelines (I.e., MCG) they still deny. Something else is going on. Just my thoughts from experience.

  2. Troy Gamble

    Do not agree with your assessment. These reviews are about insurance company profits which run in the billions. No physician in the day of healthcare worker shortages want to keep any patient a day longer unless absolutely necessary. We are the only industry known to man who has to survive on a 40 cents on the dollar reimbursement. Insurance and government are driving good people out of medicine daily. Things like continuity that matter are driving the quality of health care down.

  3. PItchar Theerathorn

    Ideally that’s how it’s supposed to work but my “peer” on the other side will tell me insufficient information has been sent but the case managers at the hospital will say they sent everything. It’s a waste of my time

  4. Amit Desai

    Agree with the overall sentiment. Observation status is a artificial concept created to reduce cost but has resulted in a beuracratic nightmare. Ironically the administrative overhead has likely increased due to hiring of more non productive non clinical FTE. Arguably Everything goes back to better documentation.

  5. Salim

    Obs vs inpatient is just a gimmick made by insurance companies to deny adequate reimbursement. Any patient who needs to stay for more than just observation literally, should technically be inpatient. We are doing everything for them the way we would do for an “inpatient”.

  6. Felix N. Alvarez, MD

    As we continue to give into insurance companies dictating how we should document & charge for services rendered. No other entity has to abide by such rules. Ask a plumber or lawyer.

  7. Lou Giorgio

    I have been admitting patients to the hospital for over years. Patients do not understand the concept of observation admit as well as the financial costs to them. Often they have said they would go home if admitted as observation. Elderly patients often incur costs that they dont expect and it creates stress for them as well as us. I agree it is also a waste of my time.

  8. Amanda Green

    I am an internal medicine hospitalist and physician adviser, and I have seen a sharp rise in denials of inpatient status stays that I have felt can be attributed to Medicare Advantage plans applying arbitrary criteria to what constitutes an inpatient admission. The teachings we have received from CDI professionals are not holding up. ICU status is basically all they consider sick enough for an inpatient admission, and sometimes not even that (DKA that turns around in 1-2 days and 80 year old patients with PE have been denied insurance approval for inpatient status).


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