Clinical Operations Improvement Archives - Page 11 of 14 - BHM Healthcare Solutions

2-Midnight Rule Continues to Confuse

2017-04-02T13:28:31-04:00By BHM Marketing|Clinical Operations Improvement, Services|

It’s been almost a year since CMS’ final ruling on the Inpatient Prospective Payment System went into effect and in that twelve month period there have been several additions made regarding conditions of payment and certifications. In case you need a refresher, the “2-Midnight Rule” is frequently talked about in healthcare and refers to criteria for determining if a patient should be classified as an admission or observation status for coding and billing purposes. While the level of treatment may not necessarily seem different from the patient’s perspective, there are subtle differences that are extremely important to how the account is coded and ultimately billed for. It also needs to be explicitly documented with intention as an inpatient admission in the patient’s chart.

3 Steps for Successful EHR Implementation

2017-04-02T13:28:34-04:00By BHM Marketing|Clinical Analysis, Clinical Operations Improvement, Compliance|

Lately there have been a number of changes in the healthcare industry that are targeted to provide quality healthcare to patients. Adapting to these changes is critical to the viability and profitability of your medical practice. 1. Implement Electronic Health Record (EHR) system If you haven’t adopted the electronic health record system, then now is the final call to do it. The government has announced July 1, 2014 deadline for physicians to implement EHR system or they will penalized beginning in 2015. Through implementation of electronic health records, physicians will be able to have complete access to comprehensive and accurate information, which will enable them to provide improved and quality medical care to patients. According to government statistics, providers using the EHR system have reported: •94% physicians said with EHR patient records are available every time •88% report EHR benefits clinical procedures of practice •75% providers reported improved patient care

Managed Care Organizations and Data Based Management

2017-04-02T13:28:34-04:00By BHM Marketing|Accountable Care Organizations, Big Data, Clinical Operations Improvement|

Managing With Data in Managed Care Organizations

In the increasingly complex world of healthcare, data based management is becoming […]

Good Medicine Is More Than an HCAHPS Score

2017-04-02T13:28:34-04:00By BHM Marketing|Clinical Analysis, Clinical Operations Improvement, Quality Improvement Programs, Services|

Improving patient satisfaction is a laudable and necessary goal for any hospital, particularly when revenue is at risk based on patients’ opinions regarding quality of care. But patient satisfaction measures should not be confused with good medicine – a nobler objective that delivers richer results. Scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) can bring bonuses to hospitals that do well on the survey. Those that don’t may risk losing some Medicare funding under the Hospital Value-Based Purchasing Program. So it’s understandable that hospitals care a great deal about HCAHPS. But the survey scores should not be seen as a proxy for good medicine.

The Quest for Healthcare Quality: Part I

2017-04-02T13:28:37-04:00By BHM Marketing|Clinical Operations Improvement, Operational Analysis, Quality Improvement Programs|

A standardized definition for quality has been elusive; though most will agree that the term “quality” in healthcare refers to the patient’s overall experience, or, encounter with the healthcare system.

3 Reasons Your Readmission Rates Are Too High

2017-04-02T13:28:39-04:00By BHM Marketing|Care Coordination, Clinical Operations Improvement, Readmissions|

Chances are, whether your on the administrative or clinical side of hospital operations, lowering readmission rates is high on your priority list. For administrators and financial officers, lowering the costs accrued from readmissions is paramount to staying under budget and for doctors and nurses, having patients prepared for life at home after discharge is the mark of truly community minded care. The patient-centered medical home purports medical decision making as an equal playing field; particularly when it comes to post-discharge measures of patient care.

ICD-10 Delay: Does ICD-10 Lack Clinical Value?

2023-07-28T14:38:28-04:00By BHM Marketing|Big Data, Clinical Analysis, Clinical Operations Improvement, Compliance, Medicare and Medicaid, Services|

ICD-10 was delayed once again as part of a bill that was meant to fix the physician reimbursement issues with Medicare. The ICD-1o delay was merely a footnote in a jam-packed bill that was going to make many doctors very happy; incidentally, pushing out the date for ICD-10 implementation also pleases many physicians. Some have gone so far as to say, on record, that ICD-10 lacks clinical value.

Hospital Acquired Infections: The Diagnosis That Could Have You Paying an Extra $40,000 Per Patient

2017-04-02T13:28:41-04:00By BHM Marketing|Clinical Operations Improvement, Financial, Healthcare Preventitive Care, Quality Improvement Programs, Services|

Hospital Acquired Infections (HAIs) occur when a patient is exposed to a bacterium, virus or fungi during their hospital stay that leads to an additional condition. These additional conditions can cost hospitals thousands of dollars in lost revenue.

Observation Units – Bridging the Gap Between Inpatient and Outpatient

2017-04-02T13:28:41-04:00By BHM Marketing|Clinical Operations Improvement, Financial, Health Insurance, Readmissions, Services|

What is CMS doing to reduce healthcare costs? CMS has added observation units which are an additional level of care between inpatient and outpatient. What Are Observation Units? In general, observation units are used to bridge the gap between inpatient and outpatient. They are designed for the patient in which the attending physician cannot determine whether a patient should be classified as outpatient (released within 48 hours) or inpatient (expected to stay at least 2 midnights). The observation units enable the physician to have a bit more time to stabilize the patient and based on medical necessity determine the estimated length of stay. They are billed as outpatient and do not count toward an inpatient admission.

2 Midnight Rule |Maximize Reimbursement

2017-04-02T13:28:41-04:00By BHM Marketing|Clinical Operations Improvement, Financial, Health Insurance, Medicare and Medicaid, Services|

What is the 2 Midnight Rule? What does it mean for your organization? How does it affect the amount Medicare patient’s pay out of pocket? How does the 2 Midnight Rule affect reimbursement from both inpatient and outpatient perspectives? The 2 Midnight Rule establishes guidelines as to whether or not a physician should admit a patient from outpatient to inpatient. The general rule is if the patient, based upon medical necessity, is expected to require care that will span at least 2 midnights, the patient should be admitted as inpatient, and therefore reimbursable under Medicare Part A. In determining the 2 midnights, all care including outpatient is used in the determination. However, in terms of reimbursement, outpatient is reimbursed via Medicare Part B provisions and inpatient is reimbursed via Medicare Part A provisions.

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Clinical Operations Improvement