Discharge Planning Guide: Tools for Compliance, Fourth Edition

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Discharge Planning Guide: Tools for Compliance, Fourth Edition

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Discharge Planning Guide: Tools for Compliance, Fourth Edition

Jackie Birmingham, RN, BSN, MS, CMAC 

Discharge planning has long been a challenge for organizations, but expected revisions to Medicare's Conditions of Participation (CoP) will increase the burden on healthcare facilities, especially in case management departments, by expanding the number and type of discharge plans that must be created. Discharge Planning Guide: Tools for Compliance, Fourth Edition, is a comprehensive resource on the changes to the CoPs, which are set to revamp discharge planning not just for hospitals, but for postacute providers as well.

This book provides guidance on developing a discharge planning workflow during a time when hospitals must create discharge plans for a larger percentage of patients than ever. Essential functions of discharge planning, including patient choice, health literacy, communicating with caregivers, and delivery of notices, are presented in a clear and concise format. The book also covers the connection between discharge planning and the revenue cycle, including payment rules, billing and coding implications, and the appropriate use of several claims forms and condition codes.

This book will help you:

  • State the purposes of the Social Security Act, the Conditions of Participation and Conditions for Coverage (CoP/CfC), and the Interpretive Guidelines as each relates to discharge planning
  • Identify sections of the CoPs for discharge planning that relate to discharge instructions
  • Explain how utilization review, discharge planning, and case management interface with transition management
  • Describe steps in monitoring the progress of a patient’s discharge plan
  • Describe the effect of the discharge planning process efficiency scores and preventable readmission
  • Describe when to use the Medicare Outpatient Observation Notice (MOON) according to the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act for observation patients
  • Discuss payment rules that affect discharge planning
  • Describe types of discharges and transfers from acute care hospitals, critical access hospitals, skilled nursing facilities, and home health agencies
  • Outline provisions of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014
  • Discuss the revenue cycle implications discharge planning has for hospitals


Continuing Education:

American Nurses Credentialing Center (ANCC)
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 3.2 nursing contact hours is provided by HCPro.

Nursing contact hours for this activity are valid from October 18, 2016, through October 18, 2018.

California Board of Registered
HCPro is approved by the California Board of Registered Nursing to provide 3.8 nursing contact hours. California BRN Provider #CEP 14494.

Commission for Case Manager Certification (CCMC)
This program has been pre-approved by the Commission for Case Manager Certification to provide continuing education credit to CCM board certified.

About the Author:

Jackie Birmingham, RN, BSN, MS, CMAC, is the vice president emerita of clinical leadership and regulatory monitoring for Curaspan Health Group. In her role, Birmingham works with industry leaders to monitor federal laws that impact the process and practice of discharge planning, transition management, and case management. She has more than 30 years of experience in transition of care healthcare settings with other organizations, including roles as director of discharge planning, director of quality improvement, and nursing school faculty.

Disclosure statement

The planners, presenters/authors, and contributors of this CE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity.

Page Count: 200
Dimensions: 8.5 X 11
ISBN: 978-1-55645-933-7

Published: October 2016

Table of Contents

1. Discharge Planning From a Case Management Perspective

i. Definitions: Utilization Review, Case Management, and More
ii. The Arrival of IPPS, DRGs, and Discharge Planning
iii. Effect of DRGs: Shortened LOS and Monitoring Admission
iv. Social Security Act and Discharge Planning
v. Revenue Cycle Management and Discharge Planning
vi. Split of QIOs Into BFCCs and QIO-QINs
vii. Medicare Integrity Program Auditors

2. Discharge Planning: The Process

i. The Six Steps of Discharge Planning
ii. Monitoring
iii. Patient/Family Education and Counseling
iv. Revenue Cycle Management

3. The Social Security Act: The Foundation of the Discharge Planning Process

i. Conditions of Participation for Discharge Planning
ii. Interpretive Guidelines
iii. Policies and Procedures
iv. Admission Review Considerations for Discharge Planners
v. Compliance Guidance for Organizations
vi. Addressing Caregiver Comfort and Patient Convenience

4. Patient Choice, Rights, and Privacy Considerations

i. Freedom of Choice
ii. Patients' Rights
iii. Option Selection for Patients: Quality and Resource Use Indicators
iv. Planning for Discharge
v. Beneficiary Notices
vi. The Important Message From Medicare
vii. The MOON and the NOTICE Act
viii. Disclosure Requirements
ix. Professional Judgment

5. Payment and Rules Affecting Discharge and Transition of Care

i. Medicare Rules for Payment
ii. Medicare and You
iii. Medicare as Secondary Payer
iv. Americans with Disabilities Act—Olmstead Act
v. Accountable Care Organizations
vi. Medicare Benefit Days
vii. Late-Day Discharges
viii. Medicare Integrity Program

6. Discharges, Transfers, and Readmission

i. Types of Discharges and Transfers
ii. The 2-Midnight Presumption and the 2-Midnight Benchmark
iii. Outpatient Surgical Service
iv. Readmissions Reduction Program
v. Bundled Payment for Care Improvement Programs

7. Special Considerations

i. Mandatory Reporting of Abusive Behavior
ii. Families, Ethnicity, and Cultural Practices
iii. Limited English Proficiency, Visual and Hearing Impairment
iv. Health Literacy
v. Discharge Instructions
vi. Immigrant Populations
vii. Emergency Medical Treatment and Active Labor Act
viii. Medical Repatriation
ix. Preadmission Screening and Resident Review
x. Integrative Setting: The Olmstead Decision

8. The IMPACT Act and PAC Levels of Care

i. Standardized Assessment Data
ii. Quality Measures
iii. Star Ratings/Quality Reporting
iv. Resource Use Measures
v. Interoperability of Data Collection and Reporting
vi. Networks of Providers
vii. Postacute Levels of Care
viii. Other Levels of Care Important to Discharge Planners
ix. Postacute Follow-Up for Patients Without a Referral

9. Documentation and Health Information Technology

i. Documenting the Discharge Process
ii. Minimum Documentation Requirements
iii. Frequency of Documentation
iv. The Important Message From Medicare
v. The NOTICE Act
vi. The MOON Notice
vii. Documenting Rounds
viii. Documenting Interdisciplinary Team Meetings and Patient-Centered Conferences
ix. Refusal of Discharge Planning
x. Sending Medical Information to Postacute Care Providers
xi. Using Health Information Technology
xii. Electronic Medical Record and Electronic Health Record: Different Uses for Similar Terms
xiii. Revenue Cycle Management and Discharge Planning Documentation
xiv. Coding a Claim: The National Uniform Billing Committee
xv. MS-DRGs and Documentation
xvi. Health Insurance Claims: Form CMS-1500 and Form UB-04
xvii. Condition Codes
xviii. Discharge Status Codes

10. Frequently Asked Questions
11. Downloadable Appendix: CMS’ Conditions of Participation for Discharge Planning