We always discharge from Rehab, admit to Acute, discharge from Acute, admit to Rehab. We have one clear cut process that handles all situations. We also had a claim check developed by Meditech to check the system for readmits within 3 days to Psych or Rehab - just in case a patient did not stay in our system and went to another facility or home. Kim %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Fri Dec 29, 2006 11:36 am From: RICHARD MCNEIL FYI %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Fri Dec 29, 2006 6:43 am From: "Jackie Welch" <jwel Subject: RE: [MEDITECH-L] RE: IRF Interrupted Stay To: "Barbara Kirtland Pena" <[EMAIL PROTECTED]>, "Valerie A. Holdener" <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>, <[email protected]> From: "Jackie Welch" <[EMAIL PROTECTED]> Date: Thu, 28 Dec 2006 09:03:54 -0600 This is a multi-part message in MIME format. --===============1560637171== Content-class: urn:content-classes:message Content-Type: multipart/alternative; boundary="----_=_NextPart_001_01C72A91.644295B4" This is a multi-part message in MIME format. ------_=_NextPart_001_01C72A91.644295B4 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable 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. =20 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 =09 =09 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. =20 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. =20 Barbara Kirtland Pe=F1a=20 Systems Information Specialist=20 Clinical Informatics St Joseph Regional Health Center, Bryan, Texas =20 =09 =20 -----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 =09 =09 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. =20 =20 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.=20 That still seems way too complicated for staff to manage well. =20 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.=20 =20 I'll let you know if we determine a magic solution after our meeting.=20 =20 =09 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]>=20 http://www.greatrivermedical.org/ <http://www.greatrivermedical.org/>=20 =20 =20 =20 -----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 =09 =09 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? =20 Thanks, Valerie ------_=_NextPart_001_01C72A91.644295B4 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD><TITLE>Message</TITLE> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <META content=3D"MSHTML 6.00.2800.1106" name=3DGENERATOR></HEAD> <BODY> <DIV><SPAN class=3D104275514-28122006><FONT face=3DArial color=3D#0000ff = size=3D2>That's=20 great when the whole thing is planned, but when the patient crumps and = goes to=20 ICU in the middle of the night is where our issues begin. No one = is=20 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"=20 process for the Rehab nursing staff and the house supervisors. =20 </FONT></SPAN></DIV> <DIV><SPAN class=3D104275514-28122006><FONT face=3DArial color=3D#0000ff = size=3D2>And=20 how do you manage PCS documentation when you continue on the same = account=20 number, then it becomes greater than three days, so should become a new=20 admission to acute? You now have three days of acute documentation = on a=20 now to be discharged three days previously from Rehab account. = It's not a=20 simple cut and dry like an LOA out of your facility is. By = always=20 discharging the patient from Rehab, new admit to other acute units you = have your=20 documentation and daily charges cleanly on the account. I suppose = we could=20 always put the Rehab patient on LOA, then always create a new account = number for=20 the other acute visit, and if this needed to be rolled into one for = billing it=20 could be managed at the back end by the business office. I = know an=20 ALWAYS is never easy, but all the variables are just too complex to = expect the=20 after hours staff nurse to remember.</FONT></SPAN></DIV> <DIV><SPAN class=3D104275514-28122006><FONT face=3DArial color=3D#0000ff = size=3D2>-=20 Jackie</FONT></SPAN></DIV> <BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px"> <DIV></DIV> <DIV class=3DOutlookMessageHeader lang=3Den-us dir=3Dltr = align=3Dleft><FONT=20 face=3DTahoma size=3D2>-----Original Message-----<BR><B>From:</B> = Barbara Kirtland=20 Pena [mailto:[EMAIL PROTECTED] <BR><B>Sent:</B> = Thursday,=20 December 28, 2006 7:27 AM<BR><B>To:</B> Jackie Welch; Valerie A. = Holdener;=20 [EMAIL PROTECTED]; [email protected]<BR><B>Cc:</B> Carolyn = A.=20 Masterson; Kathy Stephens<BR><B>Subject:</B> RE: [MEDITECH-L] RE: IRF=20 Interrupted Stay<BR><BR></FONT></DIV> <DIV><SPAN class=3D805351513-28122006><FONT face=3DBatang = color=3D#000080 size=3D2>Our=20 Rehab staff actually use the LOA prompt on the Inpatient Transfer = routine to=20 place a patient going to our Acute facility, ER or Outpatient=20 Surgery location, with expectations of returning, into a = Free=20 LOA-Leave of Absence-status, (F) which can last up to 3 = days. While=20 in Free LOA status, no room charges or Inpatient statistics are = counted=20 for the patient. A new account is created for the new = services. =20 If the patient returns within the 3 days, the LOA status is set = to R,=20 effective the day the patient returns, and the room charges and = Inpatient=20 statistics resume for the patient. If the patient does not = return within=20 3 days, the LOA status is set to R, effective the day the patient left = and the=20 patient is discharged as of that date. Free LOA days are billed = as non=20 covered days.</FONT></SPAN></DIV> <DIV><SPAN class=3D805351513-28122006><FONT face=3DBatang = color=3D#000080=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D805351513-28122006><FONT face=3DBatang = color=3D#000080=20 size=3D2>Access to the LOA field is restricted to only a few users who = determine=20 when to use it appropriately and to prevent incorrect use which can = effect=20 room charging. Rehab case managers monitor LOA=20 activity.</FONT></SPAN></DIV> <DIV><SPAN class=3D805351513-28122006><FONT face=3DBatang = color=3D#000080=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D805351513-28122006> <P><FONT face=3D"Monotype Corsiva" color=3D#000080>Barbara Kirtland = Pe=F1a</FONT>=20 <BR><FONT face=3DTahoma color=3D#000080 size=3D2>Systems Information=20 Specialist</FONT> <BR><FONT face=3DTahoma color=3D#000080 = size=3D2>Clinical=20 Informatics</FONT></P> <P><SPAN class=3D805351513-28122006><FONT face=3DTahoma = color=3D#000080 size=3D2>St=20 Joseph Regional Health Center, Bryan, Texas</FONT></SPAN></P> <P><SPAN class=3D805351513-28122006></SPAN> </P> <P><FONT face=3DTahoma color=3D#000080 size=3D2></FONT><FONT = face=3DTahoma=20 color=3D#000080 size=3D2></FONT><FONT face=3DTahoma color=3D#000080=20 size=3D2></FONT><BR> </P></SPAN></DIV> <BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px"> <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT = face=3DTahoma=20 size=3D2>-----Original Message-----<BR><B>From:</B> = [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]<B>On Behalf Of </B>Jackie=20 Welch<BR><B>Sent:</B> Wednesday, December 27, 2006 1:56 = PM<BR><B>To:</B>=20 Valerie A. Holdener; [EMAIL PROTECTED];=20 [email protected]<BR><B>Cc:</B> Carolyn A. Masterson; Kathy=20 Stephens<BR><B>Subject:</B> [MEDITECH-L] RE: IRF Interrupted=20 Stay<BR><BR></FONT></DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2>This is timely. I have a meeting scheduled this week to = discuss the=20 issues of inpatient rehab patients who may have to be transferred to = ICU or=20 another acute care unit. (It always is confusing and frequently = handled=20 incorrectly.) Too much of how you need to handle this is based upon = third=20 party payer, and no staff nurse should need to know this = information. The=20 nurse' s priority needs to be the patient being transferred. =20 </FONT></SPAN></DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff size=3D2>My=20 recommendation is going to be that Rehab should ALWAYS discharge the = patient, then register as a new admit to an acute = unit. =20 Upon discharge from the acute care unit, if the patient is making a=20 scheduled return to Rehab, then a case manager should have the time = to=20 determine if the original account number should be = resumed. If=20 so, then the registration staff will have to UNDO that original=20 Rehab discharge, change to LOA or whatever for the days on the = acute=20 unit, and the documentation resume on this original number. = Otherwise, a new=20 number will be issued. </FONT></SPAN></DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2>That still seems way too complicated for staff to manage=20 well.</FONT></SPAN></DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2>Perhaps the best idea is to have clean cut admits and = discharges for=20 each of these now three different visits. (REHAB/ACUTE/REHAB) = Then,=20 the billing and insurance folks can manage on the back end. = Again, I=20 don't think the staff nurse caring for the patient should be = burdened with=20 making these decisions. A clear cut process needs to be in = place.=20 </FONT></SPAN></DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2>I'll let you know if we determine a magic solution after = our meeting.=20 </FONT></SPAN></DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D146384419-27122006> <DIV align=3Dleft><FONT face=3D"Arial Black" color=3D#800000 = size=3D2><EM>Jackie=20 Welch RN BSN</EM></FONT></DIV> <DIV align=3Dleft><FONT face=3DArial size=3D2><EM>Clinical Systems=20 Manager</EM></FONT></DIV> <DIV align=3Dleft><FONT face=3DArial size=3D2><EM>Information=20 Systems</EM></FONT></DIV> <DIV align=3Dleft><EM><FONT face=3DArial size=3D2>Great River Health = Systems</FONT></EM></DIV> <DIV align=3Dleft><FONT face=3DArial size=3D2><EM>1221 South Gear=20 Avenue</EM></FONT></DIV> <DIV align=3Dleft><FONT face=3DArial size=3D2><EM>West Burlington, = Iowa=20 52655</EM></FONT></DIV> <DIV align=3Dleft><FONT face=3DArial = size=3D2><EM>319.768.4417</EM></FONT></DIV> <DIV align=3Dleft><FONT face=3DArial size=3D2><A=20 = href=3D"mailto:[EMAIL PROTECTED]"><EM>[EMAIL PROTECTED]</EM></A></FONT></DIV>= <DIV align=3Dleft><FONT face=3DArial size=3D2><A=20 = href=3D"http://www.greatrivermedical.org/";><EM>http://www.greatrivermedic= al.org/</EM></A></FONT></DIV> <DIV align=3Dleft><FONT face=3DArial = size=3D2><EM></EM></FONT> </DIV> <DIV align=3Dleft><FONT face=3DArial=20 size=3D2><EM></EM></FONT> </DIV></SPAN></DIV> <DIV><SPAN class=3D146384419-27122006><FONT face=3DArial = color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px"> <DIV></DIV> <DIV class=3DOutlookMessageHeader lang=3Den-us dir=3Dltr = align=3Dleft><FONT=20 face=3DTahoma size=3D2>-----Original Message-----<BR><B>From:</B> = Valerie A.=20 Holdener [mailto:[EMAIL PROTECTED] <BR><B>Sent:</B>=20 Thursday, December 21, 2006 2:49 PM<BR><B>To:</B> = [EMAIL PROTECTED];=20 [email protected]<BR><B>Cc:</B> Kathy Stephens; Carolyn A.=20 Masterson<BR><B>Subject:</B> IRF Interrupted = Stay<BR><BR></FONT></DIV> <DIV><FONT face=3DArial size=3D2><SPAN = class=3D186053520-21122006>We have a=20 Inpatient Rehab Facility were recently a patient was in the IRF = then=20 transferred to our medical floor for one day and then = returned to the=20 IRF. According to Medicare we can bill for this "interrupted = stay,"=20 as we can be reimbursed; however, we're not sure how to process = it. =20 Do we place the account in a "leave of absent status" or take it = back to a=20 "Pre" status and then when they come back we remove the "leave of = absence"=20 or "Pre" and place the patient back in on the same Account = Number,=20 stopping the day count for the dates they were out of the = IRF? Does=20 anyone have any ideas or policies on how this = works?</SPAN></FONT></DIV> <DIV><FONT face=3DArial size=3D2><SPAN=20 class=3D186053520-21122006></SPAN></FONT> </DIV> <DIV><FONT face=3DArial size=3D2><SPAN=20 class=3D186053520-21122006>Thanks,</SPAN></FONT></DIV> <DIV><FONT face=3DArial size=3D2><SPAN=20 = class=3D186053520-21122006>Valerie</SPAN></FONT></DIV></BLOCKQUOTE></BLOC= KQUOTE></BLOCKQUOTE> = <html><br><br> <b>CONFIDENTIALITY NOTICE:</b> <p>This e-mail and any files transmitted with it are confidential and may= contain health information protected by law. Any unauthorized use or di= sclosure is strictly prohibited. If you are not the intended recipient, = please notify the sender by return email, delete this email, and destroy = any copies. Please note that any views or opinions presented in this e-m= ail are solely those of the author and do not necessarily represent those= of Southcoast. The recipient should check this e-mail and any attachmen= ts for the presence of viruses. Southcoast accepts no liability for any d= amage caused by any virus transmitted by this e-mail.</p> </html> = </BODY></HTML> =00 ------_=_NextPart_001_01C72A91.644295B4-- --===============1560637171== Content-Type: text/plain; charset="us-ascii" MIME-Version: 1.0 Content-Transfer-Encoding: 7bit Content-Disposition: inline =*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*= To subscribe or unsubscribe to the meditech-l, visit MTUsers.COM. To check the status of the meditech-l, visit MTUsers.NET. For help, email [EMAIL PROTECTED] ______________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l --===============1560637171==-- -------------------------------------------------------------------------------- Return-Path: <"Jackie Welch" <[EMAIL PROTECTED]>> Received: from southcoast.org by SLH.ORG; Fri, 29 Dec 2006 06:43:01 0000 Received: from smtp1.slh.southcoast.org (unverified [10.0.0.48]) by southcoast.org (Rockliffe SMTPRA 6.1.17) with SMTP id <[EMAIL PROTECTED]> for <[EMAIL PROTECTED]>; Fri, 29 Dec 2006 06:40:37 -0500 Received: from prosonic.com ([204.202.252.254]) by smtp1.slh.southcoast.org (SAVSMTP 3.1.6.45) with SMTP id M2006122906403730163 for <[EMAIL PROTECTED]>; Fri, 29 Dec 2006 06:40:37 -0500 Received: from prosonic.iserver.net (localhost [127.0.0.1]) by prosonic.com (8.13.6.20060614/8.13.1) with ESMTP id kBTBW10t019469; Fri, 29 Dec 2006 11:32:30 GMT Received: from IS-SC-01.grhs.net (mailhost.grhs.net [69.18.40.198]) by prosonic.com (8.13.6.20060614/8.13.1) with ESMTP id kBSF41Xg092218 for <[email protected]>; Thu, 28 Dec 2006 15:04:01 GMT X-SEF-Processed: 5_0_0_910__2006_12_28_09_03_55 X-SEF-7853D99-ADF1-478E-8894-213D316B8FFA: 1 Received: from Unknown [10.18.2.4] by IS-SC-01.grhs.net - SurfControl E-mail Filter (5.2.0); Thu, 28 Dec 2006 09:03:54 -0600 X-MimeOLE: Produced By Microsoft Exchange V6.5 Content-class: urn:content-classes:message MIME-Version: 1.0 Subject: RE: [MEDITECH-L] RE: IRF Interrupted Stay Date: Thu, 28 Dec 2006 09:03:54 -0600 Message-ID: <[EMAIL PROTECTED]> X-MS-Has-Attach: X-MS-TNEF-Correlator: Thread-Topic: [MEDITECH-L] RE: IRF Interrupted Stay Thread-Index: AccqhB8IFtAEFZpySMi82+KLvuwqFQADBbaA From: "Jackie Welch" <[EMAIL PROTECTED]> To: "Barbara Kirtland Pena" <[EMAIL PROTECTED]>, "Valerie A. 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CONFIDENTIALITY NOTICE: This e-mail and any files transmitted with it are confidential and may contain health information protected by law. Any unauthorized use or disclosure is strictly prohibited. If you are not the intended recipient, please notify the sender by return email, delete this email, and destroy any copies. Please note that any views or opinions presented in this e-mail are solely those of the author and do not necessarily represent those of Southcoast. The recipient should check this e-mail and any attachments for the presence of viruses. Southcoast accepts no liability for any damage caused by any virus transmitted by this e-mail. =*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*= To subscribe or unsubscribe to the meditech-l, visit MTUsers.COM. To check the status of the meditech-l, visit MTUsers.NET. For help, email [EMAIL PROTECTED] ______________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l
