We follow the Medicare guidelines across the board. If there is a guideline for another payer, we typically take care of that on the back-end. We use the LOA function when a patient leaves the ARU, and if they do not return within the allotted time frame for the interrupted stay, the LOA is undone and the patient is retroactively discharged. If the patient returns within that time frame, we return them from LOA and resume documenting and charging on the original account.
(At least that is the way we have it set up...not always perfect!) Stephanie Alford MIS Project Coordinator Sid Peterson Memorial Hospital Kerrville, Texas 830-258-7572 ________________________________ From: [email protected] [mailto:[EMAIL PROTECTED] On 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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