Reimbursement policy reminder: observation services

As a reminder, Anthem Blue Cross and Blue Shield allows reimbursement for observation services when ordered by a physician or other individual authorized by state licensure law and facility staff bylaws to admit members to the hospital or order outpatient tests. This is the case unless provider, state, federal, or contracts and/or requirements indicate otherwise.

The member’s medical record documentation for observation services must include a written order that clearly states, admit to observation. Additionally, such documentation should demonstrate that observation services are required by stating the specific problem, and the treatment and/or frequency of the skilled service expected to be provided. The designated observation service status, in general, will not exceed 24 hours.

For specific policy details, visit the Reimbursement Policy page on the provider website.