Sunday, July 08, 2007

medicare, what to do

so ive been covering for one of the social workers at the hospital, and will continue to do so for two more weeks. the hardest part of this, for me, is that everytime i come into cover, the rules that govern the hospital have changed. this time it is a new medicare policy that adds extra paperwork for me when i dont have enough time to get everything done as it is (the unit is already understaffed, and the doctors get angry at me for not getting the patients out faster, but i will not comprimise the level of care i give to meet beaurocratic demands)...

the new policy allows patients to appeal their discharge from the hospital, which in theory i agree with, as sometimes i think people are d/c'ed before they are ready, but on the other hand, neither the patient nor medicare are responsible for paying for the days while the appeal process takes place, and the hospital must eat the cost (and people are amazed at the situation in california regaurding patient dumping, but its rather logical- unethical, but logical)

anyhow, i cut out the meat of this new policy and have pasted it here

Revised Notification of Discharge Appeal Rights

...CMS published a final rule changing the requirements for notifying inpatients about their hospital discharge rights.... The most noteworthy change in the final rule is the substitution of a revised “Important Message from Medicare” (“IM”) beneficiary notice of non-coverage in place of the additional generic notice that CMS had proposed. The final rule also expands prior law requiring hospitals to provide a notice of non-coverage only when the beneficiary disagreed with the discharge decision.

oh and i divided it up into sections to make it feel a little more managable :)
Standardized Notice of Discharge
The notice must contain the following information:

the beneficiary’s rights as a hospital inpatient, including the right to benefits for inpatient services and for post-hospital services;
the beneficiary’s right to request an expedited determination of the discharge decision, and an explanation of that process and alternative appeals procedures;
a description of the circumstances under which a beneficiary will or will not be liable for charges for a continued stay in the hospital...Under the final rule, a beneficiary may submit a request for expedited review of a discharge decision to the applicable Quality Improvement Organization (QIO) in writing or by telephone no later than the day of discharge....Under the final rule, the failure to make this request in a timely fashion may result in beneficiary liability for the services. When the QIO notifies the hospital that the beneficiary has requested expedited review, the hospital must provide a more detailed read of the policy, her eis a pdf containing the following information: pdf for details

and finally
Notably, the new rule has no effect on the existing policy regarding the financial liability for a patient’s extended stay during a review. CMS still considers such costs to be hospital operating costs covered by the overall diagnosis-related group payments.

Song of the day: theyre coming to take me away- napolean xiv


HitThaFloor said...

My Dad's oncologist left "BIG HOSPITAL" for private practice so that he didn't have to compromise patient care and I applaud him for that. It takes as long as it takes. He's not a factory. Of course, on the other end, my Dad has waited for a long time in the waiting room. A really long time. But when he gets in, it takes as long as it takes.

molly said...

interestinghcopice for an oncologist...and i imagine he must still be contracted with a hospital so he can admit patients when agressive treatment is needed

...for me, more and more, i am disgusted that we have a pay-for-treatment system at has led to high levels of debt and financially based a way its like genocide

if more people were like your dad, and willing to wait a little(although, i have to say, i have top wait atleast 20-45 minutes for all of my doctors, we might be willing to change to a humanistic medical system in which everyone has an equal right to life (which i dont believe we have in this country)

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