Course Provider
Learning Objectives
• Define observation coverage, billing, coding, and payment rules
• Discuss the appropriate application of ABNs for observation patients
• State the new/revised inpatient order and certification requirements
• Explain CMS’ 2-midnight rule benchmark
• Describe the effect of hospital practice patterns on the 2-midnight presumption
• Recognize exceptions to the 2-midnight benchmark
• Describe the impact of LCD/NCD/CED criteria on inpatient coverage
• State the rules for "inpatient-only" procedure billing and reimbursement
• Describe the differences between condition codes 44 and W2
• Use appropriate billing codes for full Part B payment for inpatient cases, including for "self-denials"