Summa Health System and a group of Medina-based doctors plan to build an outpatient surgery center and physician offices in Medina, OH. Construction on the 75,000-square-foot building, which will also house diagnostic testing and other outpatient services, is expected to begin late this summer. It will be completed in about 14 months. The center will be built on Ohio 18 on 10 acres straddling Medina and Montville Township. Summa and NorthEast Ohio Management Service Organization have an additional 20 acres for future development.
There are 29 medically based fitness and wellness centers all over Greater Cleveland, according to the Medical Fitness Association, a nonprofit organization whose board of doctors reviews the centers and offers advice to make them more effective. They range from loose affiliations between hospitals and local recreation centers, to rehabilitation centers where patients can continue to use the facilities at low cost, to full-service free-standing monuments of fitness that compete with, and can cost more than, most health clubs. The increasing popularity of these centers mirrors a national trend toward an appreciation of the wellness concept, that prevention is indeed the best possible medicine. There are now more than 800 fitness centers affiliated with hospitals in the country, according to the MFA, a number that continues to rise each year.
Medicare and Medicaid Services finalized two payment reforms in August 2007 that took effect Oct. These changes could have a significant impact on your organization's accounts receivable and medical records processing. In order to lessen their impact, it is important to understand the nature of the reforms and make appropriate alterations to your internal processes.
The Inpatient Prospective Payment System applies to discharges occurring on or after Oct. 1. The Present On Admission Indicator took effect on the same day, and it requires Medicare providers to submit a POA Indicator for every diagnosis on inpatient acute-care hospital claims. Critical-access hospitals, Maryland waiver hospitals, long-term care hospitals, cancer hospitals, psychiatric hospitals, inpatient rehabilitation facilities and children's inpatient facilities are exempt from this requirement.
What to Watch For
No more than five days of revenue should be held in the accounts that are discharged-not-billed. Listed below are some key processes that should be monitored to avoid challenges. Each facility is encouraged to check these as well as hospital-specific processes.
Action Steps to Take
Be aware that Discharge Not Billed due to coding greater than five days (including records pending physician query) increases overall DNB.
Track and trend physician queries by physician and diagnosis. Have you identified issues related to inconsistent, missing, conflicting or unclear documentation that must be resolved by the provider?
Monitor physician queries older than seven business days.
Work with practicing physicians to explain the importance of their role in these new requirements. POA reporting requires a joint effort between the healthcare provider and the health information management professional coding the information to ensure complete and accurate documentation, code assignment, and reporting of diagnoses and procedures.
It is important to understand that POA codes will be reported to CMS and will eventually be used for payment/reimbursement purposes by CMS.
Update annual coding accuracy data for each coder by conducting an external coding audit.
Examine whether the number of claims rejected by the electronic claims management system due to medical records issues has increased.
How to Measure DNB
Measure Days Revenue Outstanding in DNB. Divide the total dollar amount (gross) of patient accounts that are discharged but not billed by the average daily (gross) revenue. The result should not exceed five. If you are over five days revenue outstanding, you may not have cause for concern because this number can fluctuate. However, if you are consistently above 10 DRO, extraordinary measures are needed.
Measure the average age of accounts at bill time. Your ECM systems should offer a "discharge to bill time" report. Otherwise, request this report from HIS. The average discharge to bill time (measured in calendar days) should be seven days or less. This report should include at least 30 days of claims.
Avoid Common Mistakes When Calculating DNB
Do not include accounts that are "in-house" (nondischarged).
Use gross revenue and gross AR data.
Include all accounts, even accounts in your system's "hold days," in discharged not billed.
Do not mistake an "uncoded" report for DNB. There may be many reasons for DNB other than coding.
Paying close attention to these internal practices will help you minimize the effect of these substantial Medicare and Medicaid reforms.
Dan Hobbs is the director of patient financial services for QHR Consulting Services and Sarah Herring is the senior consultant for health information management for QHR Consulting Services in Brentwood, TN. They may be reached at dan_hobbs@qhr.com or sarah_herring@qhr.com respectively.
I have always had serious doubts about that saying, but if misery does in fact love company, hospital leaders should now take heart. You now have company in what some of you see as a Congressional witch hunt. That's because you have now been joined by about 136 colleges and universities as targets of federal probes about whether your institutions deserve their rich tax breaks. In the case of institutions of higher learning, Congress is poking around about how they use their endowment largesse.
Sens. Max Baucus (D-MT) and Charles Grassley (R-IA), the finance cops in the Senate, have now included colleges and universities in the long-running investigation over how charitable organizations use their money. They sent out a letter and survey (remember that, hospital CEOs?) last fall to colleges with at least $500 million in their endowments, seeking information about how that money is spent. Colleges grew their endowments an average of 21 percent in the last year while tuition growth continues to outpace inflation. With colleges, the open-ended, wide-ranging fact-finding investigation focuses on how they are using (or not using) their big endowments to help people afford the tuition at their chosen school, while in healthcare, it focuses on whether nonprofit hospitals deserve their federal tax exemption based on the amount of unreimbursed care they provide to the destitute.
The fact that the Senate Finance Committee is digging into other nonprofits with deep pockets might give hospital executives cold comfort, although it should reduce their persecution complex.
Baucus and Grassley are doing good work. At least among hospitals, there are bad actors that take advantage of their nonprofit status to pad their endowment, their profit margin, or their executives' pockets while using every trick in the book to avoid shelling out those bucks for uncompensated care. They are few, but they need to be reined in. A fair policy on how much is enough, in the case of providing uncompensated care, as well as accounting and reporting standards to go with it, would be a welcome evolution, at least among the hospital executives I talk with. You'll hear it bandied about in the media as a community benefit standard, which, of course, doesn't currently exist.
All the same, the hospital executives I talk to regularly believe the long-running investigation is doing serious public relations damage to the hospitals that do take seriously their charitable mission. Colleges are now finding that their community benefit standard is now under at least as much scrutiny. For example, I like college athletics as much as the next guy, but whether donations to the multimillion-dollar business that college athletics has become should be tax-deductible is an eminently fair question to ask. Similarly, as Grassley has been quoted, "it's fair to ask whether a college kid should have to wash dishes in the dining hall to pay his tuition when his college has a billion dollars in the bank."
Though their missions couldn't be more different, in most cases, hospitals and colleges are being scrutinized for the same reason: They continue to raise prices significantly--for healthcare and tuition, respectively--while building their profit margin and endowments at similarly high rates. While that equation might be perfect for a profit-making entity, it's clearly problematic for organizations that profess to deserve tax breaks because of their charitable missions.
Where this will all lead is anyone's guess, but at least hospitals are no longer being singled out.
The Food and Drug Administration has approved Medtronic's Endeavor zotarolimus-eluting coronary stent system to be used in the treatment of coronary artery disease. It is the first new drug-eluting stent to be approved by the FDA since 2004.
Horizon Blue Cross Blue Shield of New Jersey has notified its members that an employee laptop computer containing personal information for about 300,000 individuals was stolen. The insurer has sent letters to thousands of its members alerting them about the theft, which occurred in Newark, NJ, on Jan. 5, 2008. Horizon says the personal information contained on the computer included names and addresses of members, but no medical data.
A bill being considered in a New Hampshire House committee seeks to tighten health information privacy regulations. If approved, the state's rules would go beyond the federal Health Insurance Portability and Accountability Act. The proposed state law also seeks to put stricter regulations on health information used for research.
As President Bush vies for electronic medical records as one way to reform the nation's ailing healthcare system, some Las Vegas physicians and health insurance carriers are buying in. Southwest Medical Associates, for example, is offering patients My SMA Health Online--which provides patients with a personal page where they can schedule, change or cancel primary care physician and pediatric doctor appointments. Patients can also request prescription renewals from their physicians, manage and update their personal account information and e-mail their physicians.
CareFirst BlueCross BlueShield has invested more than $1.5 million in two electronic patient records initiatives in Maryland. CareFirst has pledged $967,000 to plan and implement an electronic patient records system at Community Health Integrated Partnership Inc., a network of seven community health centers. The company also is contributing $550,000 to an $800,000 project at LifeBridge Health to allow patients electronic access to their doctors and hospitals.
