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.
Do we give a MOON letter to a patient who was originally assigned to inpatient status, but then reassigned to observation services when the utilization review committee determined that he or she did not meet inpatient criteria. In this instance, condition code 44 was used and the patient’s status was changed to observation. If we are required to deliver the MOON form in this situation, should it be given to the patient at the same time as the patient is given information on condition code 44?
Just before the Medicare Outpatient Observation Notice (MOON) requirement became effective March 8, CMS added another hoop to jump through in an open door forum held February 28. The discussion in that forum forced many organizations to change course at the last minute as CMS announced it would not allow pre-populated check boxes in the free-text field of the MOON designated for describing clinical reasons for the service the patient receives. Organizations that had listened to experts touting the value of adding check boxes with specific rationale to the MOON were forced to revamp the form shortly before implementation.
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.
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.
