Admission and discharge dates are used to bill for a patient stay. There are certain rules which apply to the to determining the LOS or ALOS for a patient. Acute care facilities have an ALOS of less than 30 days and long care facilities provide care for long than 30 days. In addition to determining LOS if a patient I readmitted for the same diagnosis within 72 hours “requires all diagnostic or outpatient services rendered during the DRG payment window (the day of and three calendar days prior to the inpatient admission) to be bundled with the inpatient services for Medicare billing ()” Capturing the accurate data and ensuring it flow accurately for coding and billing to process smoothly. Due to the numerous services that are provided through
Abbey, D. C. (2010). Healthcare payment systems: Fee schedule payment systems. CRC Press. Retrieved from http://books.google.com/books?id=1uxIcqBAu_EC&dq=fee schedule payment system&source=gbs_navlinks_s
Constructive discharge, or constructive dismissal, means that the employee resigned from their position as a result of the employer creating an intolerable and difficult environment. Constructive discharge is viewed as the employee being pressured to quit due to the employer making changes to the working conditions or responsibilities, but from a legal position, the employee quit due to forced termination, or fired without good cause. ("TimsLaw.com » Constructive Discharge - Being forced to quit - Tim 's Missouri Employment Law Info Site," n.d.)
State and federal regulations, national accreditation standards, and clinical practice standards are created, and updated regularly. In addition, to these regulations, OIG publishes a compliance work plan annually that focuses on protecting the integrity of the program, and prevention of fraud and abuse. The Office of the Inspector General examines quality‐of‐care issues in nursing facilities, organizations, community‐based settings and occurrences in which the programs may have been billed for medically unnecessary services. The Office of the Inspector General’s work plan for the fiscal year 2011 highlights five areas of investigation for acute care hospitals. Reliability of hospital-reported quality measure data, hospital readmissions, hospital admissions with conditions
As a new nurse that was approaching my first anniversary of employment, I made the very tough decision to return to school to obtain my BSN. I began the RN-BSN program with the University of Texas at Arlington (UTA) in August of 2015. My life was already very busy, along with having two children, a husband, and reentering the workforce in a new field, I decided that taking one course at a time would work best for my busy schedule. My focus was to take as many classes as possible, without breaks by following the start dates with the UTA program. There were pre-requisite classes from other schools that I overlapped with the RN-BSN classes because I wanted to complete the program as quickly as possible.
Medicare part A payment reimbursement is done through a Prospective payment system (PPS). Under the PPS Medicare payment is based on a predetermined, fixed amount. In order to determine the payment amount for a particular service different classification systems are used based on setting type 6. In fact, Centers for Medicare & Medicaid services (CMS) use separate PPSs all together for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities 6. Since implementation of the PPS to each of these settings, healthcare providers (i.e. Physical Therapists) have faced many challenges.
Transitioning from Registered Nurse (RN) to Nurse Practitioner (NP) can bring many challenges. This transition begins when a person starts graduate education and doesn’t end until a few years after gaining the position of NP. Having a proper support system, a job that is interesting, and a keen sense of self-awareness are all important factors to a successful transition. Using appropriate coping mechanisms can make this transition much easier. Knowing the possible obstacles and understanding how to overcome them will also ease the change.
To enable a positive change in discharge time, the physicians would need to be engaged and accountable for their part in the initiative. Environmental Services would need to be educated on how bed turnaround time affects patient flow and they can help make this initiative successful. Social Services and Case Management would be integral in the process. Assuring that barriers to patient discharges are addressed early. In addition, nurses would need education on this initiative and positive effects that would be seen as a result of its success. Nurses will have to prioritize to assure their care and responsibilities do not cause delays. Improved teamwork between centralized bed placement staff and unit staff would help assure smooth flow of patients. Administration needs to continue to be highly visible throughout the initiation of this change and on a continued basis to sustain the positive effects of the change (White & Griffith,
As new nursing graduates begin the process of transition into the nursing practice. There are many challenges and issues which are associated throughout the transition. New graduates may embark their journey through a graduate program or seek employment solo. The transition period may consist of challenges, that students will encounter during their journey. This essay will identify, discuss and critically reflect nursing key challenges that student nurses may face, throughout the process of the transition phase. The nursing key challenges chosen for this essay include professionalism, preparation, personal factors, competency factors, patient- centered care and job satisfaction. These nursing challenges will be thoroughly discussed and supported by current evidenced based research and nursing literature.
7, p. 35). This change in system also has reduced the time patients are at the hospital by 30 minutes (Robbins et al., 2021), which could potentially allow for more patients to be seen in a
Strong difference of opinions. There was never a specific reason for discharging me. At the time it was agreed upon between both parties that “going separate ways” was the best option.
I had the opportunity to meet with Dee Laguerra for a few hours and learned so much about the Medical records side of our facility and its impact on healthcare organization. As Director of Health Information Management (HIM) she is responsible for many aspects of managing the medical record; which is a legal document. I did not realize how complex this department is and how vital this department is to the legal and financial position of the organization. Dee’s position as director is the responsibility for the collection, organizing, scanning, and completions of the medical records in a timely matter after the patient is discharged. The reason for the timeliness of scanning the medical records is for the preparation for the coders to review all the charts to code for insurance billing. The time requirement for th...
Each day we are faced with making decisions regarding the plan of care and discharge of a patient based on the number of days an insurance company allows to treat the patient. Most times the days allowed are less than what is required to assist the patient back to their prior level of function and ability to safely return home. This causes an internal struggle for the provider and can lead to easily accepting what the insurance company allows even though it is not always best for the patient. Typically, we follow the rule of always doing what is right, which could mean that we keep the patient on the unit longer than the insurance will provide payment.
P-The patient will continue to comply with the program policy and her next scheduled appointment is scheduled on 03/28/2016 at
With the explosive growth in the 1990s of managed care that were sold by health insurance companies, physicians were suddenly renamed “providers.” That began the deprofessionalization of medicine, and within a short time patient became “consumers” (The New York Times). The shifts in American medicine are clearly leading to physicians' losing power, which results in deprofessionalization. The subsequent deprofessionalization of physicians should not surprise Americans. Although many people spend time and effort evaluating the present state of medicine, they fail to integrate an important piece of information: physicians and sociologists predicted all of today's events more than ten years ago (Hensel, 1988).
The diagnoses associated with the hospital stay are placed into groups requiring a similar intensity of services. The DRG reimbursement, similar to the system used by the federal Medicare program, is based on the average cost of providing services for the specific diagnosis group, regardless of how long a specific client may have actually been in the hospital. The department does adjust payments for exceptionally long stays or exceptionally high costs. It also pays hospitals for the capital costs associated with the Medicaid inpatient