Author Archive for PARC Editor
The Patient Access Resource Center is your one-stop resource for managerial, training and compliance needs of the patient access manager. Here, you can find the latest news, benchmarking reports, newsletter articles, and practical scenarios to help your every-day needs.
Benchmarking in patient access
We presented an audio conference, “Use Patient Access Benchmarks to Improve Registration Accuracy,” September 22.
These days, it seems all patient access departments are ramping up efforts to be accurate, considering the economic climate.
Take a look at some of the tools we offered during the show:
- Audit tool for consistent education
- Training checklist
- Manual monitoring tool
- Outline of Albany Medical Center's training program
- Productivity standards
- Dashboards
- Audit QA
- Standard set of elements of scorecard
AHA RAC Program Update answers provider questions
And while DRG and coding reviews could begin as soon as November, the AHA says CMS may delay the onset of medical necessity reviews so it can first establish a process that would give providers the ability to re-bill all eligible outpatient claims. CMS previously announced medical necessity reviews would begin in January 2010.
Establish a relationship with patient financial services staff
The crossover between patient access and case management is natural. Share this tip with your ED case managers:
Patient financial services (PFS) counselors offer various assistance to patients. They:
- Speak with patients about insurance coverage or the lack thereof
- Offer to assist with originating a Medicaid or free/charity care application
- Try to answer any questions related to the financial obligations resulting from the patient’s ED visit/hospitalization
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Workers’ compensation
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No-fault motor vehicle insurance
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State crime victims’ insurance funds
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Charity care, such as professional home visits, durable medical equipment, or free transportation
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Individual state public health resources
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Individual hospital funded programs for post acute needs
Another Medicaid reduction possible when stimulus funds are gone
Source: American Medical Association
CMS releases new RAC FAQ
Q: How long is the RAC discussion period?A: The discussion period begins with the time of notification (demand letter for automated reviews and the review results letter for complex reviews) through the time recoupment occurs. The discussion period normally requires written notification to the RAC. The discussion period does not extend the provider's appeal time frames.
Patient deportation case highlights issues with illegal alien healthcare
A medical ethicist says people who are angry at a South Florida hospital for repatriating a brain-damaged patient to his native Guatemala should instead push Congress to expand emergency healthcare coverage to illegal aliens.
Arthur Caplan, a professor of bioethics at the University of Pennsylvania Center for Bioethics, says Martin Memorial Medical Center was unfairly criticized after the Stuart, FL hospital chartered an airplane and returned Luis Jimenez, 37, to his native Guatemala in 2003.
The hospital had been providing unreimbursed long-term care for the uninsured day laborer ever since he suffered severe head injuries in a 2000 automobile accident that left him partially paralyzed. The hospital placed the value of the uncompensated care at around $1.5 million.
"Those who are outraged over sending him home should try to push for illegal aliens to be covered. Good luck with that," Caplan says. "You can yell at the hospital all you want, but if he was in a public plan they probably would have kept him here because he would have had coverage. In a way, each one of us decided to send him home."
Source: HealthLeaders Media
Health coverage does not protect against incurring medical debt
Health insurance does not safeguard people against medical debt in California, where one in seven non-elderly adults is trying to pay off healthcare bills in excess of $2,000. Of those with debt, 1.4 million, or two-thirds, have health coverage.
"More than 2.2 million Californians, or 13% of nonelderly adults, reported having medical debt," according to the survey, "The State of Health Insurance in California." Among those 2.2 million, 17% had debts from $2,000 to $4,000; 9.4% were paying debts between $4,000 and $8,000, and 8.7% had debt about $8,000.
The nation's largest state health survey was conducted by the UCLA Center for Health Policy Research, which conducted telephone surveys of 50,000 California residents between June 2007 and early March 2008. The survey is part of a biennial project, but its release sends a message to those trying to craft health reform proposals, the authors said.
Source: HealthLeaders Media.
Confront, correct, counsel disruptive physicians
Susan Reynolds, MD, is not a regular viewer of the television show "House," the medical drama that features a brilliant but obnoxious physician who is tolerated in spite of his abusive behavior with colleagues and personal shortcomings that include drug abuse.
"I hate House. There is no way in the world that that doctor would ever exist," says Reynolds, the president and CEO of the Institute for Medical Leadership in Los Angeles.
Reynolds should know. At one time a practicing emergency physician, Reynolds now provides medical groups with coaching, counseling, and strategies for handling problem doctors. Business is good.
Read the full story in HealthLeaders Media by John Commins.
Inpatient HINNs – Protecting the hospital’s right to recover payment for non-covered services
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of this passage.
Last month, I participated in an HCPro audioconference on HINNs. "HINN" stands for hospital-issued notice of non-coverage. It’s the inpatient equivalent of an advanced beneficiary notice (ABN).
Under Medicare’s limitation on liability (LOL) provisions, hospitals are required to provide prior notice, in a prescribed form, when certain outpatient or inpatient services ordered by a physician do not meet Medicare’s medical necessity guidelines for the patient’s condition.
In such cases, the ABN is the prescribed form of prior notice for outpatient services, while the HINN is the prescribed from of prior notice for inpatient services. Although the prior notice requirements for LOL have been in place for a number of years, hospitals continue to struggle to provide timely, appropriate notification, particularly in the inpatient setting.
What are the benefits of using whiteboards to track patient discharges?
Imagine a communication tool in patient rooms that allows interaction between the patient, his or her family members, and all the patient’s caregivers.
This tool is the whiteboard placed at the foot of each patient’s bed, often referred to as “the ticket home” or “the ticket to discharge,” because not every patient is discharged home.
Newly implemented at Tufts Medical Center in Boston, whiteboards used in this way have proven to have many benefits.
Check out the September 2009 issue of Case Management Monthly to read the full article, and discover the benefits of becoming a Case Management Monthly subscriber.