-
A third of patients seen at one Arizona emergency department (ED) were uninsured, but this percentage was cut in half after a checkout process was implemented, reports Todd B. Taylor, MD, FACEP, a Phoenix, AZ-based consultant specializing in Emergency Medical Treatment and Labor Act (EMTALA) compliance.
-
When speaking with a payer representative, verify eligibility first, then move on to more specific details such as service category and codes, recommends John T. Porter Jr., access denial analyst for patient financial services at Scripps Health in San Diego.
-
The fact that payers almost never give a guarantee of payment prior to service and require registrars to confirm that there is no guarantee should set off warning bells when verifying coverage information, says John T. Porter Jr., access denial analyst for patient financial services at Scripps Health in San Diego, CA.
-
Recently, a large payer denied a claim for a CT scan of the abdomen due to no authorization, even though a registrar previously had been told none was required.
-
At Harris Health System in Houston, patient access staff identify patients who fall into the category of self-pay or under insured, but the completion of the application and follow-up is outsourced, reports Veronica Rodriguez Patricio, audit, appeals, quality assurance, and training manager for eligibility and registration services.
-
The emergency department is evolving from being the gate of the hospital to being a front porch for the community, a central location where people with healthcare concerns can come and be triaged to the proper venue for care, says Karen Zander, RN, MS, CCMAC, FAAN, principal and co-owner of The Center for Case Management in Wellesley, MA.
-
Faced with a growing uninsured population, The MetroHealth System in Cleveland created an HMO-like system in 2010 to provide care for uninsured patients and embedded case managers in the health system's 11 clinics to ensure that uninsured patients get the care they need to avoid emergency department visits and hospitalization.
-
Community Memorial Hospital's Intensive Case Management Program, which connects frequent emergency department users with appropriate community-based services, has decreased emergency department visits by 42% for a cost savings of $157,769, acute care admissions by 44%, saving $370,475, and reduced the average length of stay by 1.2 days for patients in the program at the 250-bed community hospital in Ventura, CA.
-
These days, if hospitals don't have case managers in the emergency department, especially during peak hours, they run the risk of losing reimbursement as well as having their facility inundated with repeat users who don't have the resources to manage their healthcare in the community.
-
The final rule for the fiscal 2013 Inpatient Prospective Payment System (IPPS), effective Oct. 1, 2012, continues the Centers for Medicare & Medicaid Services' (CMS) move to tie reimbursement to quality, rather than merely quantity, and makes it more important than ever for case managers to ensure that documentation in the medical record is complete and clearly reflects the patient's severity of illness, says Susan Wallace, MEd RHIA, CCS, CDIP, CCDS, director of compliance/inpatient consultant for Administrative Consultant Service, LLC, a healthcare consulting firm based in Shawnee, OK.
