leaving hospital against medical advice

Is there anything special I need to indicate on a claim form when a patient leaves the hospital against medical advice? The patient was admitted to the hospital and the next day the doctor went to see her again and discovered the patient missing from her room. So, it wasn't exactly against medical advice...the patient just disappeared and the hospital staff was unable to find her. Hospital security gave up searching and assumed she left the hospital based on comments she had made earlier in the day. While the ethical and legal ramifications for this certainly deserve discussion, my question is simply about how to bill it.

Do I just submit the admission claim as usual? Will an AMA be paid? The patient is covered by a Medicaid HMO.

Thanks!

Just bill for your visit

and you should get paid. No special designation for AMA on the claim. But I hope the doc wasn't the first one to find her gone. If the insurer denies the claim, bill the patient! (You won't get anything except the satisfaction of billing someone with Medicaid but that is priceless)

its sad

our doctor was in fact the first to find her gone...if he hadn't gone at that time to do his rounding, who knows when they would have discovered her missing...makes you wonder, huh?

thanks for the advice!

Ama

If physician did not have face-to-face (patient gone), no charge is submitted.

subsequent care

To clarify, no charge for the day she went missing. The admit should be billed because it was a service performed.

gotcha

I will bill the initial visit on the day she was admitted and leave it at that.

Thanks!

Update --insurance denial

Just thought I'd post an update in case anyone has this problem in the future. I have not yet billed the charges...I was going to do that today. But waiting in my mailbox this morning was a copy of a letter sent from the insurance to the hospital denying their charges for this patient. The hospital billed as inpatient with Day 1 as admitted and Day 2 (the day patient disappeared) as discharged. Insurance will only approve an observation stay.

I'm going to verify the hospital changed patient status to observation and then bill my doctor's one visit under an observation status.

So that it interesting

The status should be based on the intent at the time of admission, not the fact that the patient left after a day. The hospital can choose to fight it but if the hospital wants to bill Observation, you should do the same- the payment is equal.