Awareness : OBC Tips

Determining Inpatient Admission Date and Time

The decision for inpatient hospital admission is a complex medical decision based on physician’s judgment and the need for medically necessary hospital care.  An inpatient admission is generally appropriate for when the patient is expected to need two (2) or more midnights of medically necessary hospital care. 

An order must be placed for the admission, to formally admit the patient into inpatient care. A common error that may occur during the review of a hospital inpatient claim, is the incorrect admission date.  The admission date and time is determined by the physician’s “admit to inpatient,” order.

For example, if a physician decides to “admit to inpatient” at 11 p.m. on January 1, 2019, the inpatient admission date would be 11 p.m. However, if the patient is in the emergency room at this time and the order is written at 11 p.m. and the patient is not transferred until midnight, what is the proper time to document? This may be a common scenario the Medicare Claims Processing Manual, Chapter 3, § 40.2.2 states that a patient is “inpatient” when a physician’s order for “inpatient” status is issued.

If the order for admission is placed on one date of service but the patient is not placed in the inpatient bed until the following day, the date of admission for purposes of charging room and board would be the date of the inpatient order was placed. If the patient expires or is discharged before he/she is assigned or occupies a room, that still means the patient was considered an “inpatient” on the day he/she was admitted and may charge for room and board.

All orders are required to be timed and dated. This is in accordance with the Medicare Conditions of Participation (CoP) and the Joint Commission (TJC), therefore the inpatient order’s date and time is what determines when the patient becomes an inpatient, regardless if the order was written just prior to midnight or where the care is being given.