MOON update provides little new guidance

March 3, 2017
Case Management Monthly

On February 2, CMS Revised its Medicare Outpatient Observation Notice (MOON) instructions in MLN Matters 9935, but the document provided little new information, primarily reiterating much of what was already said in the 2017 IPPS final rule.

“CMS went into great detail on delivery of the MOON when the patient is not competent, but completely ignored providing details on the amount of specificity needed in completing the box specifying ‘the reason the patient is outpatient,’ ” says Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at R1 Physician Advisory Services in Chicago. “This was one of the least helpful publications I have seen from CMS.”

For case management professionals, keeping up with the MOON revisions has been a challenge.

Training can help your organization navigate issues related to SNF three-day qualifying stays

March 10, 2017
Case Management Monthly

Organizations today are putting a lot of energy into getting ready to comply with the NOTICE Act and Medicare Outpatient Observation Notice (MOON) guidelines, which go into effect on March 8 (see related story on p. 1). But this new notification requirement is giving them a related headache to contend with as well: issues related to the three-day qualifying inpatient stay required for Medicare coverage of the SNF benefit. The NOTICE Act is intended to ensure patients are aware of their status and the financial implications it may have for them—in particular, how it might affect their postacute care options.

Sample FAQ: Skilled nursing facilities and the three-day rule

March 17, 2017
Case Management Monthly

The following is a question and answer form created by Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at R1 Physician Advisory Services in Chicago, to help outline some basics regarding the complex rules surrounding the three-day qualifying stay required, which Medicare requires in order for patients to qualify for the skilled nursing facility (SNF) benefit.You can use this as a starting point to create your own physician and provider training materials on this topic. Ensuring that providers are well-trained on this topic can help ensure patients get accurate information, which can make these discussions less difficult. 

Director's desk: Establishing a successful mentoring program

March 24, 2017
Case Management Monthly

How many of us have a successful mentoring program established in our organization and department? For most organizations, I would venture to say mentoring is performed on a piecemeal basis and is likely not as effective as it could be. Far too often, mentoring efforts are disorganized and lack a dedicated trainer. If any training is given, it often consists of the same general orientation afforded to all new employees, regardless of the job they will be doing.

Complex case: The importance of validating second-party payer coverage in trauma cases

March 31, 2017
Case Management Monthly

Sally, a case manager assigned to surgical cases, has noticed a recent increase in challenging insurance cases since her hospital brought on a new trauma surgeon. One such challenging case began Christmas Eve, when an 80-year-old female patient with several fractures was admitted to Sally’s unit. The patient shared with Sally that her injury occurred when she tripped while exiting a major super store. She fell face first on an icy sidewalk. She had just finished her holiday shopping and all her presents were scattered in front of her. The ambulance drivers had been so accommodating. Before transporting the patient, they collected all the gifts and delivered them to the nearest hospital with the patient.