For physicians, office managers and billing staff

Important information about billing and documentation of observation services

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Facility observation services

Facility observation services are specific, clinically appropriate outpatient services provided to help a healthcare professional decide whether a patient needs to be admitted as an inpatient or can be discharged.

Humana conducts medical record reviews for services to confirm services meet medical necessity, billing and documentation requirements. No payment is rendered for services that are not medically necessary or documented in medical records or for services inappropriately billed. For specific information about the relevant review criteria for our Medicare Advantage, commercial and Medicaid plans, review our Observation Services policy on the Humana claims payment policies page.