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.
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.
MACs vs. RACs: could competition mean more bad news for providers?
What's the difference between a MAC and a RAC?
When it comes to protecting Medicare dollars, they share the responsibility of ensuring healthcare providers are paid correctly for services provided, and both conduct audits to help ensure as much.
But once a MAC audits a service, a RAC cannot. And vice versa. So, does that mean there might be a little friendly competition between them?
Read the full story by Andrea Kraynak of HealthLeaders Media.
Going low tech might reduce costly hospital admissions in chronic heart failure
Any hospital dealing with significant numbers of congestive heart failure patients would want to reduce costly admissions with better management for people in their homes. And Inova Mount Vernon Hospital, a 237-bed facility in Northern Virginia, is no different.
That's why it promptly embraced an idea to monitor its CHF patients' daily weight and symptoms without having to see them in a healthcare setting. So it turned to a concept that uses surprisingly simple technology: a scale and a telephone, to learn the earliest signs of fluid buildup and treat those patients before their disease gets out of control.
The process, using Pharos Innovations' Tel-Assurance Remote Patient Monitoring Platform, takes only three minutes.
Read the full story by HealthLeaders Media's Cheryl Clark.
Use these phrases to avoid conflict with patients, families, colleagues
This week’s tip comes from Karen Zander, RN, MS, CMAC, FAAN, principal and co-owner of The Center for Case Management in Wellesley, MA.
Mastering useful responses for difficult situations can help case management professionals remain patient- and family-centered.
These phrases facilitate communication because they allow a moment or two to take a deep breath and think.
They are the ultimate ways to include people who may not want to be included in the task of teamwork (in the case of healthcare professionals and departments) or getting through their acute care hospitalization (as in the case of patients or families.)
- It’s your right
- Used: When patients or families demand services or permission that legally are their right, but that you think may not be in their best interest
- Why it works: Conveys that you know they can do whatever they want, so it calms the situation and enables them to hear both sides
- What am I missing?
- Used: When you really disagree with someone and can’t ascertain why they don’t understand you
- Why it works: It gives them an opportunity to be heard and you an opportunity to learn what you might be missing. Everyone saves face
- We are a team
- Used: When there is a question about authority or someone is trying to divide the team
- Why it works: It reminds everyone (including you) to be a team player until you can resolve any disagreements