December 09, 2013

Due to new Medicare regulations, the process to assign an admission status for patients have changed.

Now, only the admitting physician is permitted to assign an admission status (i.e. patient class, such as inpatient, observation, bedded outpatient) in EPIC. This must be completed by an order entered at the time of admission to the hospital.

The new rule, referred to as the Two-Midnight Rule, requires:

• Written order from the admitting physician at the time of admission to the hospital
• In situations where verbal/telephone order mode is used,  the treating physician must sign this admission order before discharge.
• Treating physicians write a certification statement indicating the patient requires hospital services which are expected to be needed for a minimum of a two-midnight span.  This is included in the order. (See order descriptions below.)
• • The two-midnight span begins with the onset of treatment in any location within the facility (e.g. ED, Surgery, Outpatient).

Other Notes:

• If the order is being entered as a verbal/telephone order on behalf of the attending physician, please remember to ask the physician which patient class he/she desires based on selection on Question 5 noted above.
• Care management is responsible for assuring that an order is present and signed before discharge. 
• Medicare patients continue to require at least a three-day qualifying inpatient stay to be transferred to an extended care facility upon discharge for Medicare to cover the post hospital stay. 

Effective Monday, Dec. 16, changes will be made to the admission orders in EPIC. The patient class selections will be a required question. The three allowed choices will be offered, which include the certification statement and description of each choice. The attending physician must enter the order and sign it before discharge. 

• Admit to Inpatient - I certify that I expect that the patient will require hospital services that span two midnights or more.
• Place in Observation - Opportunity to evaluate a medically unstable condition or to determine the need for possible inpatient admission.
• Place in Bedded Outpatient - Patient requires treatment or monitoring normally obtained in a hospital outpatient department but that department is closed.