That's great when the whole thing is planned, but when the patient crumps and
goes to ICU in the middle of the night is where our issues begin. No one is
thinking about the third party payer, all the rules and regs, nor should they.
This is why I'd like to develop an "ALWAYS handle in this manner" process for
the Rehab nursing staff and the house supervisors.
And how do you manage PCS documentation when you continue on the same account
number, then it becomes greater than three days, so should become a new
admission to acute? You now have three days of acute documentation on a now to
be discharged three days previously from Rehab account. It's not a simple cut
and dry like an LOA out of your facility is. By always discharging the
patient from Rehab, new admit to other acute units you have your documentation
and daily charges cleanly on the account. I suppose we could always put the
Rehab patient on LOA, then always create a new account number for the other
acute visit, and if this needed to be rolled into one for billing it could be
managed at the back end by the business office. I know an ALWAYS is never
easy, but all the variables are just too complex to expect the after hours
staff nurse to remember.
- Jackie
-----Original Message-----
From: Barbara Kirtland Pena [mailto:[EMAIL PROTECTED]
Sent: Thursday, December 28, 2006 7:27 AM
To: Jackie Welch; Valerie A. Holdener; [EMAIL PROTECTED];
[email protected]
Cc: Carolyn A. Masterson; Kathy Stephens
Subject: RE: [MEDITECH-L] RE: IRF Interrupted Stay
Our Rehab staff actually use the LOA prompt on the Inpatient Transfer
routine to place a patient going to our Acute facility, ER or Outpatient
Surgery location, with expectations of returning, into a Free LOA-Leave of
Absence-status, (F) which can last up to 3 days. While in Free LOA status, no
room charges or Inpatient statistics are counted for the patient. A new
account is created for the new services. If the patient returns within the 3
days, the LOA status is set to R, effective the day the patient returns, and
the room charges and Inpatient statistics resume for the patient. If the
patient does not return within 3 days, the LOA status is set to R, effective
the day the patient left and the patient is discharged as of that date. Free
LOA days are billed as non covered days.
Access to the LOA field is restricted to only a few users who determine
when to use it appropriately and to prevent incorrect use which can effect room
charging. Rehab case managers monitor LOA activity.
Barbara Kirtland Peña
Systems Information Specialist
Clinical Informatics
St Joseph Regional Health Center, Bryan, Texas
-----Original Message-----
From: [email protected] [mailto:[EMAIL PROTECTED] Behalf
Of Jackie Welch
Sent: Wednesday, December 27, 2006 1:56 PM
To: Valerie A. Holdener; [EMAIL PROTECTED];
[email protected]
Cc: Carolyn A. Masterson; Kathy Stephens
Subject: [MEDITECH-L] RE: IRF Interrupted Stay
This is timely. I have a meeting scheduled this week to discuss
the issues of inpatient rehab patients who may have to be transferred to ICU or
another acute care unit. (It always is confusing and frequently handled
incorrectly.) Too much of how you need to handle this is based upon third party
payer, and no staff nurse should need to know this information. The nurse' s
priority needs to be the patient being transferred.
My recommendation is going to be that Rehab should ALWAYS
discharge the patient, then register as a new admit to an acute unit. Upon
discharge from the acute care unit, if the patient is making a scheduled return
to Rehab, then a case manager should have the time to determine if the
original account number should be resumed. If so, then the registration staff
will have to UNDO that original Rehab discharge, change to LOA or whatever for
the days on the acute unit, and the documentation resume on this original
number. Otherwise, a new number will be issued.
That still seems way too complicated for staff to manage well.
Perhaps the best idea is to have clean cut admits and
discharges for each of these now three different visits. (REHAB/ACUTE/REHAB)
Then, the billing and insurance folks can manage on the back end. Again, I
don't think the staff nurse caring for the patient should be burdened with
making these decisions. A clear cut process needs to be in place.
I'll let you know if we determine a magic solution after our
meeting.
Jackie Welch RN BSN
Clinical Systems Manager
Information Systems
Great River Health Systems
1221 South Gear Avenue
West Burlington, Iowa 52655
319.768.4417
[EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
http://www.greatrivermedical.org/
<http://www.greatrivermedical.org/>
-----Original Message-----
From: Valerie A. Holdener [mailto:[EMAIL PROTECTED]
Sent: Thursday, December 21, 2006 2:49 PM
To: [EMAIL PROTECTED]; [email protected]
Cc: Kathy Stephens; Carolyn A. Masterson
Subject: IRF Interrupted Stay
We have a Inpatient Rehab Facility were recently a
patient was in the IRF then transferred to our medical floor for one day and
then returned to the IRF. According to Medicare we can bill for this
"interrupted stay," as we can be reimbursed; however, we're not sure how to
process it. Do we place the account in a "leave of absent status" or take it
back to a "Pre" status and then when they come back we remove the "leave of
absence" or "Pre" and place the patient back in on the same Account Number,
stopping the day count for the dates they were out of the IRF? Does anyone
have any ideas or policies on how this works?
Thanks,
Valerie
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