Extra diagnostic testing can cost hospitals big
December 1, 2009
Extra diagnostic testing can cost hospitals big
Hospitals are losing large amounts of money on extra and inappropriate diagnostic testing and procedures, as well as outpatient procedures performed in the inpatient setting, because third-party payers frequently are denying the claims, says Brenda Keeling, RN, CPHQ, CPUR, of Patient Response, a Milburn, OK, health care consulting firm.
"Case managers should be on the lookout for unnecessary resource utilization, because their hospitals aren't going to get paid for it. If they see something in the chart that might be questionable, they should query the physicians about it," she says.
"Often patients come in with one acute care diagnosis and the physician orders diagnostic testing for other complaints that have no correlation to the acute care condition that prompted the admission," Ms. Keeling says.
For instance, a patient may come in with pneumonia and complain of having back pain for six months, so the doctor orders an MRI. The chronic back pain has nothing to do with the acute reason the patient is hospitalized, so the hospital is utilizing expensive resources for which there will be no additional reimbursement, she adds.
MRIs of the extremities or the spine for chronic pain rarely can be justified in the acute care setting unless the patient was recently injured, Ms. Keeling says.
Another example would be a patient who comes to the emergency department with a possible gastrointestinal bleed, is hospitalized, and receives an esophagogastroduodenoscopy (EGD).