Flipping from Obs to Inpt

Specialties Case Management


Specializes in Tele.


I had a question regarding switching from Obs to Inpt. In my previous experience, the physician was the only one who could make this change. In my new position, the CM notifies Admitting to make the change from Obs to Inpt if it's been more than 24hrs and the patient is not planned to be discharged. I wasn't sure if it's out of a CM's scope to change that status without notifiying the MD as this wasn't my practice in the past. Any thoughts?

Specializes in Med-Surg, Peds, Ortho, LTC and MORE.

AT my place changing from Oberservation to Inpatient has more to do with billing than the care type. We as nurses must watch the hours and change status ourselves. Hope that helps you.

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

Where I work and have worked in the past, there is a process that allows for a secondary review if there is disagreement or conflict with a patient’s status. If a recommendation is made to change a patient’s status, the status is not changed without proper medical orders. In other words, if the Attending disagrees with the change, then it is noted and the MDs on the reviewing committee consult the Attending. Also, patients that surpass 24 hours are not automatically changed to inpatient status. 24 hours does not change a patient’s level of care rather a patient's SI and IS makes the difference upon concurrent review.

With that said, maybe there are standing medical orders in your facility along with protocols that addresses your concerns? If not, I would question the powers -that-be regarding this practice because you may be correct that the Nurse CMs in your facility are working outside of his/her nursing scope of practice. Good Luck.

Specializes in Emergency, Trauma, Critical Care.

Whoa...that seems out of scope. I've had to deny stays where the patient rolled inpatient when they left at the 36 hour mark. They just didn't meet inpatient criteria.

I have reviewed for a RAC and I can assure you that CMS requires an MD order to admit. Your organization is committing fraud.

Specializes in Revenue Integrity, Rehab, RAC Auditor.

I am a Revenue Integrity Nurse and deny any obs to Inpatient orders without a signed MD order. According to Medicare and Insurance guidelines a patient is not allowed to be changed from obs to IP without a signed MD order-otherwise it is considered fraud.

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