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Regulatory MonitoringArchive for September, 2008
When a hospital’s emergency department is overflowing and ambulances just keep coming, it has become a common practice to divert some of those ambulances to other area hospitals.
However, turning ambulances away is no longer an option for facilities in Massachusetts. The state government has ordered a halt to the practice by January 1. State officials say that while diverting may help some hospitals with overcrowding, the costs usually outweigh the benefits.
According to The Boston Globe, diverting ambulances decreases patient choice, ties up vehicles, and often just shifts the crowding to other hospitals. In addition, not allowing some patients to enter may prevent them from going to the hospital where their medical records are kept.
This change will force hospitals to devise different strategies to keep patients from crowding into hallways in the emergency department.
Source: The Boston Globe
Editor’s note: The following is an excerpt from the HCPro, Inc.’s book, The Patient Access Director’s Handbook, co-authored by Sandra J. Wolfskill, FHFMA, and Marilyn H. Lipka, MBA. The full story will appear in the October issue of Patient Access Advisor.
Scripting involves identifying common situations, activities, and questions posed to patient access and teaching staff and how to answer appropriately to project the caring, professional image of a staff member working hard to exceed the customer’s expectations.
The most difficult part of implementing scripted responses is to develop the appropriate responses and train the staff. Thereafter, all managers and supervisors must be held responsible for monitoring staff compliance with the use of the expected responses and statements.
If management fails to hold staff accountable for following the scripts, then the entire scripting exercise is a waste of time and money. Hold your staff accountable for following the scripts so the scripting exercise proves to be time and money well spent rather than wasted.
This week’s tip, an “Ask the Expert,” is provided by Karen Zander, RN, MS, CMAC, FAAN.
Q: How can we change the culture to make case management easier to do day after day?
A: Culture is actually the sum total “collection” of the behaviors that have been rewarded and otherwise tolerated. Behaviors stem from many sources, including knowledge (one would hope!), beliefs, past experiences, and incentives. Culture will change when behaviors change, not the other way around.
So start expecting a few different behaviors, and behave differently in a few strategic places. For example, instead of starting to talk right away on the phone to someone you want something from, apologize for interrupting the person, and then ask if he or she can spend a minute to hear your concern. The recipient of this type of request may be more amenable to problem-solving with you.
Have a tip you’d like to share? Or maybe a question for our experts? Email it to editor jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!
The Justice Department increased efforts in the 1990s to fight healthcare fraud by relying on private citizens with inside knowledge. Whistle-blowers are now credited with more than 90% of the department’s healthcare fraud lawsuits.
To read the full story in Yahoo News, click here.
Medicare Secondary Payer (MSP) RACs collected $12.7 million in its demonstration project. Although CMS discontinued the MSP RACs, it will still check for MSP compliance in the nationwide permanent program.
Following are two important tips regarding the MSP from Kimberly Anderwood Hoy, JD, CPC, director of Medicare and Compliance for HCPro, Inc.:
1. Use CMS’s MSP form optionally. This is a common misunderstanding in patient access. CMS has a requirement to collect and report MSP information, but the questionnaire itself is optional. In response to a question from HCPro, Inc. after its July 16 Hospital Open Door Forum, CMS said the questionnaire is permissive in nature, but the same type of questions must be asked.
“Providers may use this as a guide to help identify other payers that may be primary to Medicare,” CMS interprets in its laws. “This questionnaire is a model of the type of questions that may be asked to help identify Medicare Secondary Payer (MSP) situations.”
2. Watch for errors in retirement dates, assumed insurance. CMS reports that most of the recoupments made by the MSP RACs are a result of claims when Medicare paid a provider when a different health insurance company should have. When a Medicare beneficiary gets health benefits through his or her job, CMS points out, that health insurance company is generally the primary payer. The government also revealed that facilities had entered information incorrectly in areas such as:
- Retirement dates
- Information on professors in California who teach well past their Medicare eligibility age
NEWS: Medicare officials underestimate incorrect payments on medical equipment
WASHINGTON – Nearly 30% of sampled claims for durable medical equipment were made incorrectly but still paid by Medicare, the Wall Street Journal reports. The report by the Health and Human Services inspector general’s office also found Medicare officials underestimated the amount of incorrect payments in 2006 for medical equipment.
To read the full story in the Wall Street Journal, click here.
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