When patients are set to be discharged from the hospital, they have the right to appeal that discharge decision. Hospitals have a duty to inform patients that they have this right by providing them with a required notification mandated by CMS called the Important Message from Medicare (IM).
Making discharge arrangements for patients leaving the facility can be challenging under the best of circumstances. But when a patient is a traveler, someone who will head back to another state or country, the difficulty factor increases exponentially.
Many case managers face the dilemma of how to cover their own assignments. When asked to cover the duties of colleagues who are ill or on vacation, the dilemmas only increase. Yet covering for another case manager is often necessary to make sure the care coordination needs of the patients and their families are met. The situation often results in both positive and negative outcomes that the team must be prepared to handle.
Determining whether a patient should be an inpatient or on observation services can be a challenging call. If the wrong decision is made or the right decision isn't properly documented, the claim will likely be denied.
It's a scenario that plays out at hospitals across thecountry each day. A Medicare patient is scheduled for a procedure typically performed on an outpatient basis. But the patient has a number of preexisting health conditions, such as chronic obstructive pulmonary disease or diabetes, which are going to make the surgery and recovery more complicated.
Sometimes the best care a patient can receive in the ED is to not be treated there at all. They can often have treatment needs and do received meds, but that does not necessarily entail an admission.
Medical City Hospital (MHC) in Dallas asked its core measurement teams for acute myocardial infarction (AMI), pneumonia, and heart failure to develop readmission reduction processes for each condition.
The Community-Based Care Transitions Program (CCTP), also known as Grant 3026, is mandated by Section 3026 of the Patient Protection andAffordable Care Act and provides funding to test models for improving care transitions for high-risk Medicare beneficiaries.
