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Not long ago, a registrar would assume a patient was providing accurate information, only to find out the claim was denied due to incorrect insurance, reports Michelle M. Mohrbach, CHAM, manager of patient access and central scheduling at Blanchard Valley Health System in Findlay, OH.
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A patient wasn't happy with the answer she received after asking registrars at Botsford Hospital in Farmington Hills, MI, the cost of a high-dollar procedure, and she insisted that she could get it performed for half of the price quoted.
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Will my insurance cover this visit?" is something patients often ask registrars in the emergency department at Sutter Delta Medical Center in Antioch, CA. However, the answer isn't as simple as it seems.
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One of the problems associated with the boarding of admitted patients in the ED is that the practice inevitably leads to increased diversion when the ED's capacity to care for new patients is diminished.
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In today's healthcare environment, as payers tighten reimbursement and auditors from Centers for Medicare & Medicaid Services and commercial payers increase their scrutiny of hospital records, hospitals need to ensure that all patients are admitted in the right level of care and that they move through the continuum as quickly and safely as possible.
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Case managers have the opportunity to provide valuable assistance to their patients who are frequently readmitted to the hospital with advanced chronic illnesses or who are approaching end of life, says Jennie Roberts, RN, CCM, MBA, chief nursing officer for Evercare Hospice and Palliative Care, based in Minneapolis, which provides hospice and palliative care services throughout the country.
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Presbyterian Healthcare Services' Hospital at Home program, which provides acute care services in the homes of patients who might otherwise be hospitalized, has improved patient satisfaction and cut the cost of hospital care by about 30% for the Albuquerque, NM-based integrated healthcare delivery system.
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Retained objects are a constant worry in any invasive procedure, but the risk has gone overlooked in obstetrics. A project from the Minnesota Health Association (MHA) is changing that situation and has practically eliminated the problem statewide.
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The Office of the Inspector General (OIG) recently released its Work Plan for the fiscal year 2013, giving risk managers a heads-up about what topics will be of most interest to regulators over the next year. Some are perennial favorites, such as fraud and abuse, but there are many new areas of focus for 2013.
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Sen. Chuck Grassley (R-Iowa) is asking three North Carolina hospitals to explain their use of a federal discount drug program after news reports described how the hospitals charge their patients a big mark-up on certain drugs, such as cancer-fighting drugs.
