Important Notice: Our web hosting provider recently started charging us for additional visits, which was unexpected. In response, we're seeking donations. Depending on the situation, we may explore different monetization options for our Community and Expert Contributors. It's crucial to provide more returns for their expertise and offer more Expert Validated Answers or AI Validated Answers. Learn more about our hosting issue here.

If the patients eligibility is determined after discharge and the admitting diagnosis is subject to review, should hospital staff submit a review request?

April 26, 2017admitting diagnosis Discharge eligibility hospital Patients review staff Subject

0

Posted

If the patients eligibility is determined after discharge and the admitting diagnosis is subject to review, should hospital staff submit a review request?

1 Answer

0

Posted

No. However, HFS will allow limited exceptions to mandatory concurrent review. If the participants eligibility was backdated to cover the hospitalization, the hospital may submit the claim to the assigned HFS Billing Consultant with a cover memorandum that explains the exceptional situation. After HFS reviews the exception request, HFS will pend the claim for retrospective prepayment review. After HFS reviews the exception request, they may pend the claim for retrospective prepayment review. HFS then sends HSI a list of cases for prepayment review. The hospital’s HSI liaison will be sent a Notice of Selection of Medical Records for Offsite Review (prepayment review) when cases are selected.