All Healed Up with Nowhere to Go

Dr. Ronald HirschJuly 24, 2023

On the June 5 edition of Monitor Mondays and in a recent RACmonitor news article, Dr. Bonny Olney from R1 RCM spoke about those patients who are stuck in the hospital without medical necessity, but also without anywhere to go. It’s happening everywhere, for many reasons. It is rare to find a hospital that is not boarding patients in the ED due to individuals in inpatient beds who cannot go anywhere due to lack of post-acute resources.


I don’t have a solution, but I will note that the American Hospital Association (AHA) has been talking to the Centers for Medicare & Medicaid Services (CMS) about establishing a per-diem payment to hospitals caring for such patients. Will that go anywhere? We can only hope so, but you might want to think about how your hospital knows which patients are there for medically necessary care and which aren’t. Are you using the appropriate occurrence span codes? Can you determine which observation hours are not medically necessary? Well, it just so happens that I discussed how you can do just that during my RACmonitor webcast.


In other happenings, there have been several speakers talking and writing about the return of the three-day inpatient requirement for patients to get their Part A skilled nursing facility (SNF) benefit. I often hear that the patient must meet inpatient criteria for every one of those three days to count. But that’s not true.


Read the full article here.

Author Bio: Dr. Ronald Hirsch is Vice President of the Regulations and Education Group at R1 RCM Inc. Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, IL. He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012, where he was Chairman of the Medical Records Committee from 1995 to 2012, and also served on the Medical Executive Committee. Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, certified in Revenue Integrity by the National Association of Healthcare Revenue Integrity, and on the Advisory Board of the American College of Physician Advisors. He is on the editorial board of He is the co-author of The Hospital Guide to Contemporary Utilization Review, with the third edition published in 2021.

Media Inquiries