-Patient reimbursement is significantly higher for inpatient care vs outpatient care for the same procedure

-CMS is increasingly vigilant in avoiding overpayment, and has enacted RAC Audits to monitor and test hospital admissions with the explicit purpose of recovering monies paid for inappropriate admissions

-CMS defines “appropriateness” of admissions as cases including, among other things, ”The medical predictability of something adverse happening to the patient;” with a foundation for that predictability being, "acceptable standards of practice…within the local medical community” and “reliance on published medical literature”

-HOS’s risk prediction tool allows hospitals, through the identification of a patient’s specific risk of complications and the application of consistent and optimal levels of care, to identify those patients eligible for APPROPRIATE admission, often resulting in an increased rate of justifiable admissions and thus increased revenues for the hospital

-As well, the capture and documentation of the patient’s specific risk along with documentation of care provided will supply future auditors with information NEEDED to justify inpatient reimbursements and protect the millions of dollars earned by the hospital

-Two different large sample studies have confirmed that 66-67% of patients fall into a moderate to high risk of bleeding and are potentially admittable