AUDIOCONFERENCE ON CD OR AUDIO ON_DEMAND
Sponsored by the Association of Clinical Documentation Improvement Specialists
presented on July 15, 2008
Unnecessary one-day stays have significant compliance and finance implications for hospitals and are a hot button issue for the Office of Inspector General (OIG). When a hospital admits a patient, it receives a full DRG payment that may not be warranted.
Patients are inadvertently admitted as inpatients when they should have been treated and released or admitted to observation only.
Often times, physicians don’t understand inpatient admission criteria and fail to effectively document the necessity for an admission. It’s not unusual for physicians to admit patients out of convenience for the patient—not because it is medically justified to do so.
One-day stays are on the rise, and with the advent of Recovery Audit Contractors (RAC), hospitals should look for ways to ensure proper admissions.
Listen to HCPro for this 90-minute, audioconference and learn how to reduce unnecessary one-day stays by training clinical staff about admission documentation and medical necessity requirements for inpatient admission. You’ll learn how to use the Program for Evaluating Payment Patterns Electronic Reports (PEPPER) to audit and monitor your hospital’s compliance.
Note: This is an intermediate-level program. Purchasers should have some knowledge of the PEPPER report and quality improvement organizations.
TAKE A LOOK AT THE AGENDA
- Why it’s important to monitor one-day stays
- RACs
- CMS focus area
- OIG audits
- Findings in Texas
- Why unnecessary one-day stays occur
- Social admissions
- Incorrect admission orders or lack of an order
- Lack of knowledge of admission criteria
- Technical Issues
- Improper transaction of an order
- computer system errors or glitches
- contractual arrangements with insurance companies
- Solutions to combat unnecessary one-day stays
- Physician and case manager education
- Condition code 44
- Drafting an admission policy
- Monitoring data and processes using PEPPER
- Case study: Ingham Regional Medical Center, Lansing, MI
- Reorganize department to improve length of stay and division of work
- Implement rapid response mechanisms to perform second reviews of admissions
- Use PEPPER report to monitor data and decrease outliers
A question-and-answer session will follow the presentation.
LEARNING OBJECTIVES
At the conclusion of this audioconference, you will be able to:
- Identify appropriate one-day stays
- Implement a process for changing patient status from inpatient to outpatient (condition code 44)
- Align hospital costs with reimbursement
- Explain the role that RACs will play relative to one-day stays
- Monitor data using PEPPER reports
FEATURED SPEAKERS
Dennis Perry, MD, MPH, is the medical director of the Department of Case Management and Utilization Review at Ingham Regional Medical Center in Lansing, MI. Dr. Perry is a physician reviewer and manages the case management and utilization review departments where he works to improve patient flow, compliance, and department efficiency. He also runs a private multi-physician practice in the Lansing area.
Judi McCabe, RN, MSHP, CPHQ, is the director of the hospital payment monitoring program at TMF Health Quality Institute in Austin, TX, where she supervises a multidisciplinary team that measures, monitors and reduces the incidence of improper fee-for-service Medicare payments. She has more than 30 years of experience in the healthcare and health insurance industries, including twenty in quality improvement.
EARN CONTINUING EDUCATION CREDITS
This program has prior approval of the American Academy of Professional Coders for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor.
BONUS MATERIAL INCLUDED IN YOUR MATERIALS PACKET!
In addition to the expertise and advice presented during this audioconference, you'll also receive a slide presentation of the program materials and copies of the following:
- One-day stay process diagram
- Audit tools
- Informational brochure for physicians
- Fact sheets for condition code 44
- Chest pain algorithm
These materials are provided with PDF links.
WHO SHOULD LISTEN?
Case managers, compliance officers, utilization review managers, HIM managers and coders, CFOs, finance managers and staff.
Chief medical officers and physicians may also find the program of interest.
AUDIO ON-DEMAND
In addition to the regular purchase option for HCPro audioconferences, we are pleased to offer another option, an audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase a CD or audio on-demand of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.
Save money when you purchase multiple copies! Ask your customer service representative about money-saving
discounts and bulk orders. Call toll free 800-650-6787 or e-mail
customerservice@hcpro.com.
