What if a patient is admitted but utilization review finds that the admission does not appear medically necessary what should the hospital do?
As described in Change Request 3444 (Transmittal 299, CMS Publication 100-04), if the hospital utilization review committee finds the inpatient admission is not appropriate, you can discuss the change in status with the attending physician and if the physician agrees, you may change the inpatient stay to outpatient stay before the patient is discharged. The physician must document concurrence in the medical record. The claim should be submitted with condition code 44.
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