Saturday, 14 December 2013

Medical Billing Errors: What can go wrong? What can you do? - 4 - The inpatient stay

Medical Billing Errors: What can go wrong? What can you do? - 3

Step 3: The inpatient stay
Dozens of people every day could provide care or services at this stage, when a patient is moved to an inpatient room. This is a labor-intensive stage that typically lasts about four days. In addition to medical care, there's an important, ongoing behind-the-scenes discussion among hospital and insurance company employees regarding the patient's condition and the medical treatment being provided. Post-operative complications, such as an infection or the need for follow-up surgery, can lengthen a patient's time in the hospital and vastly increase the number of hospital staff involved.
Room transfer

Treatment begins when the patient has stabilized and a room is open. The patient is moved from the recovery room to an inpatient room.
• A hospital care coordinator who calls for a room assignment can affect the charges on a bill, particularly if that person makes a mistake and the patient ends up in a more expensive room than insurance will cover. But the employee who actually pushes the patient from one room to another is typically included in the daily room charge.
Days of care
The bulk of patient care -- and therefore the most chances for mistakes that affect a bill -- comes during the inpatient stay. The severity of a patient's condition dictates the number of people who provide care. The list of people entering the room each day making notes on the chart "could be endless," said one executive at University Hospitals. Several hospital executives estimate that 30 people a day or more, over a typical stay of four days, provide care that later becomes part of the bill.
Some of these people become familiar faces to the patient, while others -- such as pharmacy staff, lab technicians and administrative employees -- might never be seen.
Finally, every bill will list a room charge. People who are not responsible for chart entries but are part of the price of the room include food service workers, janitors and orderlies. The room price also includes supplies that cannot be billed separately, such as pillows and light bulbs, and the overhead for nursing staff.
• The nurses are the foundation of a patient's care. They perform a range of duties from taking blood pressure to changing bandages to giving medication. With shift changes, there will be at least three main nurses each day, 12 total, tending to a patient.
• And there are many others on the clinical staff providing patient care. At a teaching hospital, this will include medical students, two a day for a total of eight; nursing students, two a day for a total of eight; residents, two a day for a total of eight; and interns, two a day for a total of eight.
 There will also be the unit's attending physicians, two a day for a total of eight; the patient's referring physician or a colleague, one a day for a total of four; four specialists or their colleagues, two times a day each for a total of 32; the surgeon or a colleague, one a day for a total of four.
• There's also a large supporting cast, including nurse practitioners, three a day for a total of 12; respiratory therapists, three a day for a total of 12; physical therapists, two a day for a total of eight; occupational therapists, one a day for a total of four; an audiologist, two times during the stay; social workers or case-management specialists, one a day for a total of four; and physician assistants, two a day for a total of eight.
• If the patient spikes a fever or has a low white blood cell count, the specialists may call in a team of about four people per specialty to help. For example, the infectious-disease team may be called in on a fever caused by infection or a team of oncologists may review a low white blood cell count if leukemia is suspected.
• Unit managers on the floor oversee a patient's clinical care, two a day for a total of eight.
• A hospital pharmacist and a couple of technicians dispense and record medication each day, three people a day for a total of 12.
• Behind the scenes, specialists and technicians read X-rays and scans, run blood and other tests, at least two a day for a total of eight.
Each person makes entries on the paper or electronic chart, providing the detail that billing department staff will translate into codes and billable amounts.
• Others who play a role at this stage include a clinical documentation specialist or utilization management specialist. (The name varies depending on the hospital, but generally one is assigned to monitor each patient.)
This person continuously reviews a patient's medical record -- ensuring that proper documentation exists for entries and that they are accurate and reflect the treatment a patient is receiving. This person frequently speaks with a representative from the insurance company and hospital doctors or other members of the clinical staff, two a day for a total of eight. Some hospitals have a doctor available to assist the documentation specialist in asking questions of the medical staff.
Loop: If a patient's condition worsens, additional treatment -- and possibly additional authorizations from the insurance company -- may be required. In cases where a patient's condition changes, the authorization process described earlier in the preregistration step often must be repeated.
At the end of a patient's stay, a hospital case manager or social worker returns and meets with the patient.
• In preparation for discharge, the case manager or social worker meets with the patient to arrange for more care as necessary. If additional care is needed, it often requires documentation by a hospital doctor and approval by the insurance company. On the day of departure, a member of the hospital's medical staff will check the patient's condition and complete a discharge disposition, a routine but vital form that becomes part of the final bill.

No comments:

Post a Comment

Popular Posts