Accurate Patient Status: Increase Hospital Revenue & Quality of Care

2 days ago2 min read

Increase revenue and quality of care through appropriate patient status.

“With CMS patient status rules constantly changing observation, it’s critical for health systems to navigate the clinical, operational, and healthcare compliance complexities to ensure appropriate care and financial stability.” -Scott Dillon, DCCS Physician Advisory Services

Why Accurate Patient Status Matters:

✅ Patient Quality and Safety Risks

Incorrect patient status can result in delayed treatment, and increased risk of poor patient outcomes.

✅ Operational Inefficiencies

Inaccurate patient status determination significantly impacts bed management, length of stay, staff deployment, and care coordination—leading to inefficiencies and bottlenecks in patient flow from admission through discharge.

✅ Patient Dissatisfaction

Patients are often confused by their status, resulting in surprise out of pocket costs, denied post-acute care opportunities and frustration with their hospital experience.

✅ Financial Risk to Hospitals

Patient status errors can trigger denied claims, audits, and can cost hospitals millions of dollars. DCCS engagements have helped hospitals clients recover an average of $8.5 million in anual revenue with proper patient status practices.

Patient Status can be Hard to Get Right

Inpatient vs Outpatient & CMS Two-Midnight Rule

Determining patient status — whether someone is inpatient, outpatient, or under observation status — is more complicated than it seems. Hospitals must assess medical necessity criteria while juggling changing CMS patient status rules, like the Two-Midnight Rule, which can be difficult to apply in real time.

Billing Errors and Reimbursement

Mistakes in hospital admission status can lead to billing errors, denied claims, and patient dissatisfaction. That’s because patient status and reimbursement are directly linked. Assigning the wrong status affects hospital revenue and can increase patients’ out-of-pocket costs.

Clinical Documentation

Even with strong case management patient status review processes, inconsistent documentation and evolving clinical conditions make it easy to get wrong. In short, accurate status determination is critical — but far from simple.

Scott Dillong, DCCS Hospital Physician Advisors

"DCCS assists hospitals with improving patient status determination, efficient care management and compliance with CMS regulations."

Scott Dillon, DCCS Hospital Physician Advisors

Struggling with patient status accuracy?

DCCS Hospital Physician Advisors specialize in aligning clinical decisions with regulatory requirements like the Two-Midnight Rule and medical necessity criteria. Our team works directly with case management, utilization review, and hospital leadership to reduce denials, optimize reimbursement, and support compliant patient status decisions.

👉 Partner with DCCS to improve your patient status processes, mitigate patient risk and protect your bottom line. To learn more:

CONTACT DCCS

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