As the Centers for Medicare & Medicaid Services (CMS) rolls out the Recovery Audit Contractor (RAC) program nationwide, case managers are in a position to help their hospitals stay ahead of the curve by keeping patients out of the hospital if they don't need to be admitted and ensuring that the documentation in the medical record for inpatient or observation admission supports medical necessity.
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Of the nearly $1 billion the Recovery Audit Contractors (RACs) identified in improper payments to hospitals and other providers, nearly 40% was the result of medical necessity denial for inpatient admissions, points out Deborah Hale, CCS, president, Administrative Consultant Service LLC, a Shawnee, OK, consulting firm.
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If your hospital frequently uses Condition Code 44 to change a patient's admission status, you may need to take a fresh look at your admissions process, according to Deborah Hale, CCS, president, Administrative Consultant Service LLC, a Shawnee, OK, consulting firm.
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At DCH Health System in Tuscaloosa, AL, clinical documentation improvement efforts go far beyond just making sure the documentation supports the most appropriate MS-DRG for the purpose of Medicare reimbursement.
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Since Baptist Memorial Hospital-Memphis began a patient throughput initiative, the patient holding hours in the emergency department and post-anesthesia care unit average less than 30 hours per day despite the fact that 50,000 patients come through the emergency department each year and the hospital has more than 30,000 inpatient visits a year.
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When patients of community-based physicians are ready for discharge from Chesapeake (VA) Regional Medical Center, they no longer have to wait for their physicians to come to the hospital and write discharge orders.
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When Chesapeake General Hospital began exploring ways to improve patient throughput and further reduce its length of stay, Roxana Ballinger, RN, BBA, CCM, director of care management, conducted research to discover what other hospitals had done to improve patient throughput and determined that nurse practitioners could play an important role in moving patients through the continuum.
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At DCH Health System, the clinical documentation improvement team takes a proactive approach to changes in the Centers for Medicare & Medicaid Services (CMS) documentation requirements.
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Automobile and accidental injury regulations, the Medicare as Secondary Payer questionnaire, and workers' compensation guidelines are just a few of the many issues with which the patient access professional and case manager must be educated and competent.
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An enterprisewide master patient index is used at Methodist Le Bonheur Healthcare, a system of six hospitals, several off-campus diagnostic and treatment centers, free-standing surgical centers, and urgent care centers.
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