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FAQ: Alabama Medicaid Patient Status Orders

Published on 

Tuesday, April 23, 2019

 | RAC Information 
 | FAQ 

Q:

We are being told that it is Alabama Medicaid Policy that we can obtain a physician order for inpatient admission after discharge on a Medicaid patient that has emergency room charges, observation charges and surgery charges. Is this true?

A:

Chapter 19 of the Alabama Medicaid Provider Billing Manual is specific for hospitals and includes the following regarding patient status orders:

Medicaid will utilize Alabama Medicaid and Pediatric Inpatient Care Criteria (SI/IS) for utilization review, billing and reimbursement purposes.

  • It is the hospital’s responsibility to utilize its own physician advisor.
  • The attending physician and/or resident may change an order up to 30 days after discharge, as long as the patient met criteria for inpatient or observation charges.”

Both the Alabama Medicaid and Pediatric Inpatient Care Criteria and a link to Chapter 19 can be accessed on the Alabama Medicaid Hospital Services webpage at http://www.medicaid.alabama.gov/content/4.0_Programs/4.4_Medical_Facilities/4.4.1_Hospital_Services.aspx

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.