Revenue Cycle

HINNs help with difficult cases

Patient Access Weekly Advisor, November 11, 2009

Patients sometimes refuse to participate in the discharge planning process as a clever way to delay discharge to the next level of care. Michael Schaeffer, LMSW, assistant director of case management/social work at Albany (NY) Medical Center, recalled a patient with a mental health condition who refused to participate and even turned staff members against each other.
“This patient triangulated the attending physician against the unit manager and against the social worker, rallying one excuse followed by another distortion,” said Schaeffer.

Eventually, the facility’s discharge planner, with consent of the attending physician, arranged for the patient to receive dialysis treatment as an outpatient.

Upon receiving the requisite Important Message from Medicare (IM), the patient appealed the hospital’s decision. However, while awaiting the Quality Improvement Organization’s (QIO) decision, the patient suddenly became more cooperative. He became more teachable and approachable and agreed to complete his Medicaid application, a task he had previously rejected.

“If anything seems to motivate and inspire people to sit up and listen, it is usually the topic of payment liability,” said Schaeffer.

The QIO ultimately upheld the hospital’s decision, and the patient received an HINN 12. He signed it and left the hospital. The patient returned to the hospital two weeks later with the same complaint, but he was much more cooperative the second time because he knew where he stood pursuant to Medicare rules.
Check out the November 2009 issue of Case Management Monthly to learn other creative ways to reduce LOS. You also can discover the benefits of becoming a Case Management Monthly subscriber.

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