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New CMS rules require changes to hospital inpatient admission orders

December 2013

On Oct. 1, 2013, Medicare implemented several hospital billing rules that heavily impact how hospitals are required to document inpatient admission orders.

The primary changes include:

1) A "two-midnight" guideline when writing "admit to inpatient" orders

2) The requirement to include the wording "admit to inpatient" for inpatient services. Inpatient status can no longer be implied by the location of a hospital bed or hospital department where services are rendered.

3) The requirement for all inpatient orders to include an estimate of the length of stay in the hospital, validated by the attending physician.

This last requirement, for an estimate of the length of stay as part of the inpatient admission orders, means that all admission orders written by residents, physician assistants and other ordering practitioners, without admitting privileges, must then be co-signed by a qualified licensed and privileged attending physician prior to the patient’s discharge from the hospital.

Epic modifications coming

Legacy is in the process of developing new workflows and order sets in Epic to accommodate the new rules and ensure compliance. Physicians can expect to start seeing changes in Epic orders and order workflows before the end of December.

All Legacy medical staff and employed physicians that provide inpatient services will be impacted by the changes, which will include a modification to the Epic inpatient admission order that references two-midnights and a process for obtaining a co-signature for providers without admitting privileges.

Legacy is currently educating physicians at monthly meetings and special education sessions, and will continue to roll out education during the next few months.

For more information, read these Legacy FAQs.

You can also check out more about the new rules in the guidance from Medicare.

If you have any questions, please contact Legacy’s Compliance Department at 503-413-5308.


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