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Faced with patients waiting for a bed for hours in the emergency department and an increase in time on ED diversion, Southern Ocean County Hospital in Manahawkin, NJ, began a hospital-wide initiative to improve throughput.
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Adapting to the sweeping changes in reimbursement mandated by the new MS-DRG system may be like suddenly having to drive on the left-hand side of the road, says Bert Amison, managing director for health care advisory services at KPMG.
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Accurate documentation always has been important but it can have an even bigger impact on reimbursement with the new MS-DRG system, according to Deborah Hale, CSS, president of Administrative Consultant Services Inc., a health care consulting firm based in Shawnee, OK.
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A recent announcement by the Centers for Medicare & Medicaid Services (CMS) that it will no longer pay for care required because of hospital error has implications for patient access.
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Putting the "know" before the "why" for patient access employees was the focus at Stevens Hospital in Edmonds, WA, during implementation of its procedure for distributing the revised "Important Message From Medicare," says Evita Armijo, patient access manager.
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Today's case managers report that they are paid more but they're working longer hours and being asked to do more documentation and paperwork.
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When it comes to the crucial arena of charge capture making sure that providers are paid at the appropriate level for all services rendered it's all about "the right charges and the right resource putting the charges in," says Gala Prabhu, a New York City-based senior manager for Accenture.
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By educating emergency department supervisors on admissions criteria and community resources, Weatherford Regional Medical Center in Weatherford, TX, has managed to eliminate most social admissions to the hospital and ensure that patients who are admitted meet admission criteria.
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The length of stay for patients being discharged to skilled nursing facilities from St. Joseph's Hospital progressive ventilator care unit dropped by 7.5 days (a 47% reduction) following a Six Sigma pilot project that focused on better ambulation of patients, earlier screening for potential skilled nursing admissions, and timely discharge.
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New rules and guidelines for Medicare Discharge Plan Appeals known officially as the "Important Message from Medicare about Your Rights" (IM) require hospitals to respond to appeals at any time, including weekends and holidays.