Background: Hospital reimbursement for medical necessity is based on the level of care a patient is receiving. In the electronic medical record (EMR), the level of care, inpatient or observation, is determined by a practitioner order or physician certification. The timeliness of this order is of utmost importance, as medical necessity is a dynamic status. [...]

Background: Insurance companies are issuing more denials and causing financial instability for hospitals. On average, hospitals are paid $6,000 less for a patient in outpatient observation status as compared to inpatient status. According to Kaiser Family Foundation Health, the average expense in 2022 for a hospital per inpatient day was $3,025 and is only increasing. [...]

Case Presentation: We present a 25-year-old female with past medical history of right fibular hemimelia who presented with acute on chronic leg pain. She had a history of multiple prior limb lengthening surgeries complicated by Staphylococcus aureus infection with hardware removal. Patient endorsed weeks of worsening leg pain and cramping. Had been seen by orthopedic [...]