Assigning the correct patient status is a constant challenge for hospitals and the case managers who are charged with ensuring these decisions are accurate.
Q: We recently received a request for a patient's records. The patient transferred to another provider several years ago and we subsequently transferred all the patient's records to the new provider. Should I direct the request to the provider the patient transferred to? I'm unsure that we should be responsible for retrieving and releasing information for this patient since we transferred the patient's entire record to the new provider.
A: If you sent a copy of the patient's records to the new provider and still have the original records, it would be appropriate for you to respond to the request. If you transferred all records to the new provider and no longer have the patient's information, refer the request to the new provider.
Editor's note: Mary Brandt, MBA, RHIA, CHE, CHPS, is a healthcare consultant specializing in healthcare regulatory compliance and operations improvement. She is also an advisory board member for BOH. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions. Opinions expressed are those of the author and do not represent HCPro or ACDIS. Email your HIPAA questions to Associate Editor Nicole Votta at nvotta@hcpro.com.
Q: I have a question about navigating the skilled nursing facility (SNF) benefit for Medicare. My understanding is that you can only use a Hospital-Issued Notices of Noncoverage (HINN) for inpatient, so you could use if less than a three-day stay. We have been giving Advance Beneficiary Notices (ABN) for our traditional Medicare patients that are observation when families are not timely on getting a SNF secured to those patients that require it. Is this correct?
Q: We provide tobacco cessation services and have been reporting these with time-based HCPCS codes. There are also CPT® codes for these services. Which is the appropriate set of codes to use for Medicare?
Q: In my facility, we are supposed to send an email to our physician advisor (PA) and to administration if a query is not answered within a week. However, this policy doesn’t work well because administration does not do anything with that information, and the PA doesn’t have time to review unanswered queries. Do you have any suggestions concerning when to let a query go unanswered?
I was under the impression that CMS said it would leave the billing for self-administered drugs to the OIG. However, we have not heard anything from the OIG. What if we are not billing for the medications?
The August 2 issue of Revenue Cycle Daily Advisor included a question about benchmark conversion rates from observation to inpatient status. With regard to that question, I think it may be helpful to know the average national conversion rate and average rate for critical access hospitals. Do you have that information?
Q: Our infusion department provides drug administration services with a physician’s order. Sometimes, the protocol includes an infusion that will run for a day or two. The company that supplies our pumps wants to bill us for the use because they say they can’t bill the insurance company–especially Medicare.
