Medicare Outpatient Observation Notice Act

Thirty minutes before evening shift change and you receive the call. A new admission is in route to your facility. The patient is reported to be of high acuity, requires intravenous antibiotics, and has a diagnosis of chronic pain. In some health care settings this would be considered a typical new patient admission. However, for rural long-term care facilities there is potential for considerable complications. In a setting where registered nurses are only required to be in the facility eight hours within a twenty-four hour time frame, significant complications can arise during admissions that require certain specialty care specific to the RN. Ineffective discharge

Patients are also entitled to receive notice on how their health information is shared by health care covered entities, and are entitled to request a report once a year, free of charge, detailing who has received copies of their health information. Another aspect of the privacy rules provides patients with the right to choose who may receive health care information. Patients should be aware, however, that the provider does not have to agree to abide by their requests. Patients may determine whether or not their private health information may be shared with family members or others. Patients may also choose where they receive their health information. They could choose to receive their information via telephone, cell phone, e-mail, or any other reasonable means of contact. HIPAA also requires that covered entities provide their policies to patients that include information on how a patient might be able to file a complaint with either the covered entity or with the U.S. Department of Health and Human Services (U.S. Department of Health and Human Services, n.d.).

The Patient Self Determination Act of 1990 formally requires any healthcare provider to give every patient upon admission

Bedside reporting involves giving information or a report to the oncoming nurse in the presence of a patient. This method gives the patient an opportunity to ask questions and get clarification regarding his or her care. Bedside reporting increases patient satisfaction, quality of healthcare and nurse-to-nurse responsibility. Hospitals need to design a better handoff process that can easily reduce patient risks and increase patients’ involvement in their care. Emergency rooms shift reports usually take place at the nursing station of every patient care area. The departing nurse gives information verbally to the oncoming shift. Therefore,

This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the Beneficiary Notices Initiative to alert the Medicare beneficiary prior to rendering the service. The Medicare beneficiary is notified via the Advance Beneficiary Notice (ABN) (see page 235 in Appendix B).

The right to receive a notice of privacy practices - Patients have the right to receive a notice explaining how a provider or health plan uses and discloses their health information.

The Department of Health and Human Services, HHS, issued the Privacy Rule to HIPAA to address the disclosure and use of a person’s health information. A branch within HHS called the Office of Civil Rights, OCR, is responsible for enforcing and implementing the privacy rule. The Privacy Rule’s main goal is to assure health information is properly protected, while allowing information to be provided and give out high quality health care. This rule is designed to be comprehensive and flexible in order to cover uses and

It covers people who are 65 or older, and it will also cover an individual under the age of 65 with certain disabilities or disease. There are four different categories within the Medicare health insurance such as part A, B, C and D. As one goes up the order the services within each category changes based on one’s need. Along with ACA and the programs such as the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) and Modernization Act has authorized CMS to pay hospital that report “designated quality measures a higher annual update to their payment rates”3, which engages hospitals to work towards value-based care. For every fiscal year CMS can place new rules and measures to determine the incentive payments for given hospital based on the reporting. Therefore, not obeying the rules of CMS will impact hospital’s incentive payments. The participated hospitals must report data to CMS, the data reported than can be used to put new measures in fiscal year so that enhancements can be made to value-based care.

To ensure an Advance Beneficiary Notice (ABN) is obtained from Medicare beneficiaries when Pullman Regional Hospital Clinic Network wishes to bill for outpatient tests and services that may not be covered by CMS or the Local Medical Review Policy (LMRP) or National Coverage Decisions (NCD) per out Intermediary.

It seems like just yesterday the entire healthcare industry was thrown into total chaos at the announcement of the transition to the new ICD-10 codes. After many physicians voiced their concern about the massive learning curve adopting the new codes, the CMS granted a stay of execution in the form of a 12-month grace period.

Although the law was enacted in August of 2015, the actual process does not start until March 2017. Within the UM department, we originally hired one nurse to review observation admissions and be responsible for giving the letter. The cost of the new nurse added approximately $63,000 dollars to the budget to ensure we were compliant with the rule. When factoring in the time needed for giving the letter on average by day, there were approximately 8 letters given per day. This number is not inclusive of the Medicare HMO’s as during the time of evaluation the only requirement was for Medicare patients. The estimated time needed to give the letters was 10 minutes or less per patient. Therefore, on average the process would annually consist of 2920 hours of nursing time. Calculating this into funding related to an average UM nurse’s salary, the hospital cost for a nurse communicating this information is $127,750/year based on the hour rate of $43.75. Not only does the hospital have cost increase, the patients also have an increase. The patient comes into the hospital knowing they will have a copay but leave with the responsibility to pay for medications they take at home. The reason for this cost is the NOTICE Act rule does not cover any prescribed medication the

On July 8, 2015, The Center for Medicare and Medicaid (CMS) called for comments on its proposed Regulation 2016 Medicare Fee Schedule. The proposed regulation was in regard to the advisability of paying for cataract surgery in the office based surgical setting.

The MOON was initiated due to the confusion of observation admissions and patients incurring bills and not being eligible for post-acute care in a Skill Nursing Facilities (SNF) because they did not know they were in observation status. The Centers for Medicare and Medicaid (CMS) uses observation status when a patient is not well enough to be discharged from the hospital and needs to be “observed” for a longer time, but the patient is not sick enough to be admitted to the hospital. As indicated by Dietsche, “There were an estimated 1.5 million observation stays among Medicare beneficiaries in 2012. The number of observation stays increased 100 percent from 2001 to 2009, likely because of financial pressure on hospitals to reduce potentially

We received the paper that Galion Community Hospital's nurses hand out to their patients. We received this information from Mary Walters the office Coordinator.

Beware! Brothers and sisters, it is greed that drive the few to side with the wolf. It is this greed you need to be aware of, as this is the one and only reason for their split to the wolf pack. God! Why must you bring this circumstance into our relationship between our own protectors and us! God help us sheep! The sheepdogs were never supposed to side with those of malpractice and negligence. Now you have brought greed into our well established relationship and led more sheepdogs away from us. Who is going to truly protect us now? God, help bring back more of our well educated sheepdogs for the sake of our patients! Too many are ill at the time, and we can’t afford to waste time with those that don’t truly care for the well-being for us sheep!