Case managers have already become familiar with the Medicare Recovery Audit Program. In January, however, government Recovery Auditors began focusing on new territory: Medicaid claims.
Editor's note: Each year HCPro's Revenue Cycle Institute reports on the experience of providers related to the Recovery Audit Program. The article below is adapted from the 2011 Recovery Auditor Benchmarking Report, released in early 2012. The summary of last year's results is by Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro. Readers can download their complimentary copy of the full report at www.revenuecycleinstitute.com.
Making sure patients are prepared for discharge can be a tricky process. When certain laws are considered, getting patients to their next destination becomes even more complex.
When case managers are looking at patients who are frequently readmitted to their facility within 30 days of their last discharge, chances are they'll find a lot of chronic heart failure (CHF) patients among them. That's because CHF patients typically have a higher readmission rate than any other disease, says Jan Lear, RN, CMC, director of case management at MedStar Franklin Square Medical Center (MFSMC) in Baltimore.
One of the riskiest times for patients comes when they are leaving the hospital and heading home or to aftercare. This is the time when medications are mixed up, follow-up doctors' appointments are missed, or discharge instructions get lost in the fax machine. Poor handoffs with poor communication can lead to unnecessary readmissions.
It's no longer a mere possibility; the Department of Health and Human Services HHS has confirmed its intent to delay the ICD-10 compliance deadline, according to its latest press release.
