Training Programs
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Regulatory MonitoringArchive for June, 2009
Q: If you submit requested medical records to RACs via CD, are you still reimbursed copying costs (i.e., 12 cents per page)?
A: Yes. You will be reimbursed for copying costs regardless of whether you send in paper copies or images on CD or DVD.
Editor’s note: Thanks to Nancy Hirschl, BS, CCS, president of Hirschl & Associates in Laguna Niguel, CA, for answering this question.
Sometimes, your health information managers need to code. And your patient access managers need to register patients.
In these tough economic times, your hospital staff members should be ready for different roles on any given day. No one is immune to change.
At Albany (NY) Medical Center, managers in the patient access department are prepared to handle staff shortages.
During a recent string of illnesses and consecutives days with short staffs, department leaders took off their managers' hats and got on the frontline to register patients.
"The leadership team are working managers, much like any other patient access area," says Cathy Pallozzi, CHAM, patient access director at Albany Medical, noting the staff recently experienced colds and GI, which sprang the managers to action. "So the managers are on the front end, as well as the associate director. If I am needed, I will be on the front end as well."
Read the full story.
In an effort to reform healthcare and reduce costs, President Obama has called for $313 billion in healthcare spending cuts.
The proposed cuts include a $220 billion reduction in hospital payments over the next 10 years. The American Hospital Association (AHA) expressed deep disappointment and noted that hospitals already face a previously announced potential $38 billion cut and $41 billion in cuts under the proposed Medicare Inpatient Prospective Payment System rule.
AHA President and CEO, Rich Umbdenstock said, “Reform must improve care for patients without crippling hospitals’ ability to care for patients and communities.”
Source: AHA News Now
Patients typically arrive at the hospital as planned, urgent, or emergent admissions, and are registered in different ways. Errors made during the registration process can have a negative impact all the way to throughput and discharge planning. For this reason, the hospital may want to consider a performance improvement project to identify if there are registration errors, the types and frequency of these errors, and when they occur. For example, do errors occur more often on emergency admission on the night shift? What types of errors are they? Are they duplicate medical record numbers, errors in Social Security numbers, or the spelling of patient names? Any of these issues will have an impact on patient safety, discharge planning, and even billing or denials.
Editor’s note: This tip comes from HCPro’s newest training resource for hospital case managers—Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes by Beverly Cunningham, MS, RN, and Toni Cesta PhD, RN, FAAN, available now at HCMarketplace.com.
Q: A patient in the ED is receiving infusion services. A physician writes an order to admit that patient as an inpatient to the regular floor. However, the patient sits in the ED for three hours waiting for a bed. Should the ED continue to bill for hours of infusion while the patient waits for a bed and as the service is provided, or does time stop when the admit order is written?
A: A patient becomes an inpatient at the time the physician writes an order for inpatient admission, regardless of whether the patient is still located in the ED. For this reason, although ED staff members continue to provide the infusion service for the patient, this service is part of the inpatient care for the patient. Providers should not bill infusion hours as an outpatient service under the outpatient prospective payment system by the ED after the time the inpatient admission order is written.
Editor’s note: Kimberly Anderwood Hoy, JD, CPC, regulatory specialist at HCPro, Inc., answered this question that appeared in the June issue of Briefings on Coding Compliance Strategies.
On June 15, the American Hospital Association (AHA) provided comments to CMS about changes outlined in the fiscal year (FY) 2010 IPPS proposed rule. In its comments, the agency questioned the proposed negative 1.9% documentation and coding adjustment (DCA) in FY 2010 and beyond, stating that CMS’ findings that real case mix index declined between FYs 2007 and 2008 is "incorrect and overstated." Instead, the AHA found "a historical pattern of steady annual increases of 1.2% and 1.3% in real case mix."
The proposed DCA would result in a cut in both operating and capital payments that total $23 billion over 10 years. Hospitals would be paid $1 billion less in FY 2010 than in FY 2009.
The AHA states, "Given the severity of the 1.9% proposed cut, and in light of the fact that our analysis shows real increases in patient severity, we ask that the agency significantly mitigate its proposed documentation and coding cut."
Hospitals may comment on the proposed rule until no later than June 30.
To read a more in-depth article about the AHA’s stance, visit www.healthleadersmedia.com.
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