Revenue Cycle

Hospital offers incentives for identifying incorrect patient status

HIM Briefings, August 1, 2016

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It's no secret that hospitals struggle with assigning the most appropriate status for patients, and this challenge is compounded by CMS' frequent changes to its regulations and guidance. To combat incorrect patient status assignments, one hospital has developed a system that rewards employees for speaking up when they suspect a patient's status is incorrect.

After an assessment of its HIM department, Montrose (Colorado) Memorial Hospital began an informal program focused on providing patient status education for physicians and engaging various departments throughout the revenue cycle in identifying whether a patient's status is correct.

The hospital had a long-standing problem with helping physicians understand how to correctly determine patient status throughout the patient's stay. For example, some providers would change a patient's status from inpatient to outpatient at the last minute if a patient seen for an inpatient-only procedure recovered quickly and could return home after one night, incorrectly assuming that a stay of one midnight?regardless of the procedure type?could not be an inpatient stay. This left other hospital staff members scrambling to change the patient's status back to inpatient or face a potential denial, says Bev Roth, BSN, case management director at Montrose Memorial Hospital.

"I tried education. I tried to pull in other departments to help," Roth says. "Case management was the lone outfielder trying to catch the fly ball before the patient went out the door."

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to HIM Briefings.

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