Because our extended care facility has a separate provider number, we discharge the patient from the extended care facility when they are transferred to an acute care unit. All orders and meds are discontinued and must be re-ordered by the physician. If the patient returns to the extended care facility, a third account is created for the new visit. If the patient is seen in the ED for a fall, an ED account is created for the treatment and billed separately. The extended care visit is NOT discharged in that case, but continued after the treatment and with a note the patient was seen in the ED.
Our billing folks insisted this was the way it should be handled and we have done so for the last 12 years, with no problems. Thanks, Betty ________________________________ From: Jackie Welch [mailto:[EMAIL PROTECTED] Sent: Thursday, December 28, 2006 10:04 AM To: Barbara Kirtland Pena; Valerie A. Holdener; [EMAIL PROTECTED]; [email protected] Cc: Carolyn A. Masterson; Kathy Stephens Subject: RE: [MEDITECH-L] RE: IRF Interrupted Stay 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. 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 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. 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. Barbara Kirtland Peña Systems Information Specialist Clinical Informatics St Joseph Regional Health Center, Bryan, Texas -----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 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. 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. That still seems way too complicated for staff to manage well. 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. I'll let you know if we determine a magic solution after our meeting. 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]> http://www.greatrivermedical.org/ <http://www.greatrivermedical.org/> -----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 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? Thanks, Valerie
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