Dispelling confusion on billing for observation services

Wednesday, June 21, 2023

Editor’s note: Ronald Hirsch, MD, FACP, CHCQM, CHRI, vice president at R1 RCM Inc. Physician Advisory Solutions, will present “Coding, Billing, and Payment Implications of Patient Status, Observation Services, and the Three-Day Payment Window” with Valerie A. Rinkle, MPA, CHRI, and Jugna Shah, MPH, CHRI, on day one of the 2023 Revenue Integrity Symposium, which will take place on September 18‒19 in Charlotte, North Carolina. Hirsch is a member of the American Case Management Association, a member of the American College of Physician Advisors, and a fellow of the American College of Physicians. Hirsch serves as an advisory board member for NAHRI.

Q: In what ways does your session challenge revenue integrity professionals to think outside the box?

Hirsch: To ensure revenue integrity, one of the fundamental goals is getting admission status correct and ensuring every hour spent in a hospital bed is properly accounted for and billed for. But with the myriad of payers we face every day, each with their own rules for status, that can be a challenge. This talk will address these ambiguities.

Q: What’s the biggest challenge in revenue integrity right now? How does your session help tackle this?

Hirsch: We are increasingly seeing payers doing their best to ensure their patients get the medical care they need, while also doing their best to avoid paying for that care. We will provide processes to hard-wire patient status.

Q: What’s one of the key pieces of information you would like people to take away from your session?

Hirsch: The use of observation must be thoughtful and proper. It is not a default service, nor is it guaranteed to be paid.

Q: What are you most excited about for this year’s topic? What are you most excited about for this year’s conference?

Hirsch: How can I not be excited about presenting with and learning from two of the titans of revenue integrity—Jugna Shah and Valerie Rinkle.

Q: What's a great piece of advice you've received regarding revenue integrity? What advice do you like to give people about revenue integrity?

Hirsch: I have a personal philosophy: Always do what is right and the money will follow. Money should never dictate what actions you take.