Observation status, InterQual screening, a physician advisor's second-level review and Medicare's three-day rule for skilled nursing all meet in NU433's Unit 3 analysis of one composite cellulitis stay. Searches like "nu 433 unit 3 assignment example", "nu433 unit 3 sample" and "nu433 unit 3 example" land here.
Thirty Hours in Observation for Cellulitis: A Utilization Management Analysis of a Patient Who Cannot Go Home Alone
[Student Name]
Purdue University Global
NU433: Case Management Across the Continuum of Care
Unit 3 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Criteria are paraphrased, not quoted; her cost exposure is bracketed.
Clinical Facts the Review Used
Temperature 37.8 °C on arrival, normal by hour 12. Redness marked at the margins, receding by hour 24. White count 13,200 falling to 10,400. Day 2 of intravenous [cefazolin]. Lives alone; poor vision; cannot manage an IV line.
Timeline
Hour 0: observation order.
Hour 6: first criteria screen by the RN case manager.
Hour 22: Medicare Outpatient Observation Notice delivered, explained and signed, inside the 36-hour window (Centers for Medicare & Medicaid Services, n.d.).
Hour 30: physician advisor review.
The Screen
Criteria set: InterQual, the licensed set at this composite hospital, acute adult subset for skin and soft tissue infection. Finding, paraphrased: stable vital signs and a response to treatment point away from inpatient care. The attending believed she needed more time; the case was referred to the physician advisor, who agreed with observation. The attending made the final order.
Payer Rules
Inpatient stays are covered under Medicare Part A; observation is an outpatient service under Part B, with her share of costs at [20 percent coinsurance for each service].
For Medicare, inpatient status is generally appropriate when the admitting practitioner expects the stay to span at least two midnights.
Traditional Medicare covers skilled nursing only after a qualifying inpatient stay of at least three days; observation days do not count.
Neither rule permits changing her status to secure skilled nursing coverage; status must follow the clinical picture.
Options
Home infusion with home health: an infusion pharmacy teaches and supplies the antibiotic; a home health nurse visits daily. Safer than a long stay for someone who wants to be home, but only if a neighbor or relative can help between visits. Cost to her: modest under Part A home health, if eligible. A longer observation stay: safe for now but adds Part B costs and does not create skilled nursing coverage. Switching to an oral antibiotic, if the attending judges her response adequate: the simplest route home.
Her Choice and the Count
She chose home with daily home health and her niece staying three nights. Any day she had stayed only for lack of a plan would have counted as an avoidable day, and the case manager's review exists partly to prevent that (Case Management Society of America, 2022). The case manager also explained, before she left, why she had been in observation and what that meant for her bill, so the notice she signed was followed by a conversation.
References
Case Management Society of America. (2022). Standards of practice for case management. Case Management Society of America.
Centers for Medicare & Medicaid Services. (n.d.). Medicare outpatient observation notice (MOON). Centers for Medicare & Medicaid Services.
How this NU433 Unit 3 example is structured
Clinical facts first, then rules, then choices, so the payer material never appears to drive the clinical judgment. The case summary gives only what the review used: vital signs, marked margins of redness, white count trend, antibiotic route and day, and her home situation. A section on levels of review explains the sequence the hospital follows: first-level screening by the RN case manager, referral to a physician advisor when criteria are not met but the attending believes admission is needed, and the attending's final order. The payer section states the two-midnight benchmark for Medicare inpatient status and the three-day rule for skilled nursing coverage, then explains why neither permits changing status to secure coverage. Options are compared on safety, her preference, and cost to her. The analysis ends by counting any day she stays only for lack of a plan as avoidable.
Get an NU433 Unit 3 example written to your instructions
Utilization prompts may hand over a chart excerpt, a payer letter or a denial to answer. Whichever arrives with your Unit 3 instructions and rubric, the model analysis names the criteria set narrowly, applies the payer rules that fit the case, and never reproduces licensed text. Turnaround is 24-48h, with the first sample free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU433 Unit 3 questions, answered
Can the paper describe InterQual or MCG criteria in detail?
Only in general terms. Both are proprietary, licensed criteria sets, so coursework names the product, describes what kind of criteria it applies, such as severity of illness and intensity of service, and states the finding in the reviewer's own words. Quoting criteria lines is usually inappropriate unless your instructor supplied excerpts for that purpose.
Does the three-day rule apply to every patient?
No. It applies to traditional Medicare coverage of a skilled nursing stay, which requires an inpatient stay of at least three consecutive days first; observation time does not count. Many Medicare Advantage plans waive it, and CMS has granted waivers to some programs. The analysis should identify the patient's coverage first, as the sample does, before stating which rule governs.
What is a physician advisor's role in utilization review?
A physician advisor provides second-level review when a case does not meet screening criteria or the case manager and attending disagree. The advisor discusses the case with the attending and gives an opinion on status, but the attending writes the order. The sample shows that conversation happening at hour 30 and records both physicians' reasoning.