I was wondering if anyone knew where I could find some guidelines for compliantly obtaining authorizations. Here’s the situation: We are an independent surgical practice who preforms operations at three different facilities. One of these facilities is giving us a hard time and threatening to cancel our cases for not obtaining inpatient authorizations. We as a practice generally follow Medicare guidelines. If the procedure is outpatient by Medicare guidelines we authorize and admit the patient as outpatient providing there are no comorbidities or extenuating circumstances that would call for an inpatient admission. The facility is requiring that we attempt to authorize all surgeries as inpatient regardless of the patients’ conditions. I personally feel this is fraudulent. If the patient only requires an outpatient stay why would we ask for inpatient just so the hospital can make more money? The latest case we have is for a spinal cord simulator trial. Leads are percutaneously placed and patients generally go home the same day. In fact we often do these at surgery centers where there is not even the option to admit. The insurance will allow an authorization for a one day inpatient stay. It seems wrong to me to authorize this for inpatient simply because they will, when this is a very black and white outpatient procedure. Can any one offer any opinions or more importantly some documentation showing that this would be wrong. I’m worried we will be responsible for obtaining these authorizations and admitting patients when it is not necessary. Thanks!