Observation Evaluation and Management Services billing and reimbursement
Governs coding, documentation, and reimbursement rules for observation evaluation and management services for providers submitting CMS-1500 and UB-92 claims to Neighborhood Health Plan of Rhode Island; affects hospital/outpatient facility services and associated departments. Applies to providers billing observation services to the plan.
No material clinical or coverage changes in this revision.
Observation Services Coverage Criteria
Observation services billing criteria
Covered when the following billing and documentation conditions are met for patients admitted specifically for observation:
ALL of the following
Observation admission applies to
- Services provided to new and established patients admitted to a hospital specifically for observation (admission need not be to a designated observation area).
- Observation includes services provided on the same date in other settings or departments associated with the observation status admission.
- This guideline applies to claims submitted on either the CMS-1500 or UB-92 claim forms.
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