Who is authorized to change patient status?

Who (and how) is authorized to change a patient's status in the hospitalist setting?
Example: The physician bills an admit code for an inpatient service but the hositalist has the patient status as Observation. Who has the authority to adjust the patient status?

Is the UR always involved?
Does a licensed physican have to order the change in status?
Does the attending/billing physician have to agree or even be involved?

Thanks, Carole

Where to start?

First, this applies to Medicare only- commercial insurers are separate. It always needs a physician order to change status. Any doctor on the case can change the status. Going from Observation to admission just requires an order "Admit as Inpatient." If the patient is admitted as Inpatient and should be Observation then a physician member of the UR committee must make a determination that the status is wrong and the attending physician must be notified of the change. If the attending agrees, then the status is changed and Condition 44 is invoked with notification of the patient that they are now Observation. If the attending does not agree then a second member of the UR committee is called and if they agree then the patient is changed to Outpatient, with the hospital unable to bill for observation hours but can bill for the other services provided.

Clear as mud? (You all probably didn't know I am also a case management expert!)