Accurate Status: Inpatient vs Observation

Right Status, Right Payment

Patient status isn’t just a billing technicality; it's a cornerstone of hospital operations that impacts reimbursement, compliance, patient satisfaction, and clinical outcomes. As hospitals shift more patients to observation status, often unintentionally, they risk losing $4,000–$7,000 per case in reimbursement.

We go beyond identifying status assignment problems - we deliver the clinical, operational, and educational strategies needed to solve them. Our approach is practical, peer-driven, and built for long-term success.

What We Do

We partner with hospitals to ensure accurate status assignment supported by clear documentation and sustainable processes. The result: higher revenue, fewer denials, and better use of beds and staff time.

Our Approach

1. Status Assignment Assessment

We start with a deep-dive to find gaps, risks, and lost revenue:

  • Retrospective Case Reviews – Focus on Two-Midnight Rule compliance, observation use, and documentation alignment

  • Workflow & Policy Review – Identify inefficiencies and inconsistencies

  • Financial Impact Analysis – Quantify revenue lost to incorrect status assignment

2. Process Optimization

We help you refine and standardize internal workflows:

  • Strengthen case management and UR collaboration

  • Standardize InterQual/MCG use

  • Improve communication with attending providers

  • Create clear escalation pathways for complex cases

3. Physician Engagement & Education

We equip physicians with the tools and training they need:

  • Focused training on status criteria and documentation that supports medical necessity and withstands payer review

  • Demonstrate that new statusing practices align with industry norms.

4. Electronic Medical Record (EMR) & Decision Support Enhancements

We optimize technology to support status decisions at the point of care:

  • Streamline order sets and admission workflows

  • Integrate prompts and documentation cues into the EHR

5. Performance Monitoring & Metrics

We help you track, manage, and improve over time:

  • Custom dashboards for key metrics (e.g., observation rates, short-stay IP)

  • KPIs and feedback loops for ongoing performance

6. Appeals & Denials Management

We strengthen your appeal strategy and reduce future denials:

  • Craft stronger appeal documentation with clear clinical rationale

  • Audit payer behavior to inform targeted interventions

Accurate patient status assignment is a key driver of clinical quality and financial performance.  When hospitals adopt our best‑practice approach, they minimize unnecessary observation use, strengthen revenue, and establish compliant and sustainable workflows that elevate both operational efficiency and the quality of patient care.