What drives specific elements of revenue cycle management with respect to discharge planning in hospitals? Discharge planners’ role in improving the revenue cycle is more proactive than reactive. This means that what discharge planners do during a patient’s hospital stay and how they document it will help the patient accounts department submit a claim likely to be paid without being audited.
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.
CMS released eight frequently asked questions related to the Medicare Outpatient Observation Notice March 8, the date by which all hospitals and critical access hospitals were required to begin delivering the new patient notice.
What do we do when families want their loved one admitted as a hospital inpatient so he or she can qualify for a transfer to a skilled nursing facility?
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.
