Don’t reinvent the wheel: Ask your vendor for help
Don’t reinvent the wheel: Ask your vendor for help
Medicare, 72-hour snags solved at OSU
Struggling with the best way to handle advance beneficiary notices (ABNs)? Need an efficient method for getting the Medicare Secondary Payer (MSP) questions answered? Don’t panic and think you have to reinvent the wheel, says Joseph Denney, CHAM, lead, patient management system implementation at The Ohio State University (OSU) Medical Center in Columbus.
Instead, go to your software vendor for help, Denney suggests. "When an issue like this comes up, we go back to our vendor, [Malvern, PA-based] SMS, because we know the same issue has got to be on the plate of every SMS client. We ask SMS, What are you doing about it?’"
That question, he says, usually leads to a collaborative solution between OSU and the vendor. In the case of the MSP questionnaire, "SMS did not have an electronic solution at the time, but being the size we are, we said, We need [a solution] custom-built.’ They took our idea and are making it a product."
OSU Medical Center also worked with SMS on processing for the Medicare 72-hour rule, which requires that charges for outpatient services that occur within 72 hours of an inpatient stay be rolled into the same account, Denney notes.
"We did custom programming on that with SMS, and now they’re looking at [making it] a product." An added benefit is that when the solution becomes a product, the vendor must compensate the hospital for its part in the design, adds Denney.
The SMS/OSU solution for the Medicare 72-hour rule processing, he explains, works like this: When a Medicare patient is admitted, the software searches the computer system, using a date range, and comes back with the information that there are, for example, two other outpatient accounts that now need to be rolled into the inpatient account.
"What was special about us is we had two rules in effect," he says. "The [OSU Medical Center] is under the 72-hour rule, and the other hospital that is attached to us, James Cancer Hospi - tal and Research Institute, is [diagnosis-related group]-exempt and under a 24-hour rule.
"We had to make [the software] go in two different directions," Denney adds. "We did custom programming to have an entity indicator. Both hospitals are on one patient management system, but via the indicator — U’ or J’ — [the software] points the admission to the correct patient accounting system."
The 72-hour solution took eight or 10 months to complete, he says.
The annual users’ conferences sponsored by virtually all major software vendors are another problem-solving source, Denney points out. "In many cases, users run the conference, and there is strength in numbers. The almighty dollar talks."
Similarly, e-mail list servers, whereby users trade questions and answers on the vendor’s products, can provide valuable feedback, he says. "I have come up against a few problems over the past four or five months and have put the question out on the SMS [list server].
"I just put one out because we are going to start to collect copays upfront in connection with [providing] ABNs," Denney adds. "We figured if we’re going to tell the patient they have to pay for a service, we might as well have them pay for it. We’re going to get into the collection game for the first time in patient access services."
Although patient accounts professionals traditionally have been more likely to subscribe to such list servers, he notes, the increased emphasis on upfront billing accuracy is changing that.
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