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HealthLeaders Daily Top Stories

HealthLeaders Media is the original producer of this content.

Having taken time out for retraining and internal audits, contractors may resume initial-phase reviews of Medicare reimbursement claims for short-stay inpatient hospital care, CMS says.


Q: Did something change with the observation services Composite APC in 2016? The director of patient financial services says we no longer receive payment for it.

A: The observation services Composite APC (APC 8009) was replaced with a single comprehensive APC (C-APC 8011) for CY 2016. Along with the new C-APC comes new status indicator J2. Services assigned to J2 are considered to be adjunctive services and components of C-APC 8011, and this will result in a single payment for these services reported as part of the comprehensive observation services APC. The J2 designation and the payment are based at the claims level and not per date of service.
The good news is that the requirements to meet the observation services C-APC are the same as for the Composite APC (e.g., clinic/ED visit, 8 or more units of G0378, etc.). Even more good news is that the ED visit level requirement now includes all Type A and Type B ED levels and critical care; the level is no longer limited to the higher ED visit levels.
Be sure that all services provided continue to be reported to insure that all costs pertaining to the individual patient’s scenario are included in your claims data. CMS will continue to expect and rely on the claims data for rate setting under the OPPS.
For more information, see the Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.3, 10.4, 290.5.1. 290.5.2 and new section 290.5.3.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Revant Solutions,in Fort Lauderdale, Florida, answered this question.

It’s an unfortunate part of healthcare today—the lawsuit. Are you ready if one is filed against your organization?

You are if your documentation is in order, says Peggy Rossi, BSN, MPA, CCM, a consulting associate for the Center for Case Management in Wellesley, Massachusetts, in her regular director’s desk column for HCPro’s Case Management Monthly (CMM). When a case is long-forgotten, good documentation can help you recall what happened and ultimately may help defend you and your healthcare employer.

Under CMS’ current Conditions of Participation for discharge planning, a hospital must document the plan and have a solid process for developing those plans that is spelled out in writing.

If any of the required discharge plan documentation or details about the interactions with the patient and his or her family is missing, the organization may run afoul of those requirements, says Rossi. This failure can result in severe sanctions to the hospital, with the worst being exclusion from participation in the Medicare program, says Rossi. This means the hospital cannot be reimbursed for services provided to Medicare beneficiaries.

Not good news.

So this should give you some pretty good reasons to make sure that staff members at your organization are dotting all those I’s and crossing all those T’s.

After all, documentation may seem like a pain, but it is clearly a task that case managers performing discharge planning must take seriously and it must be performed after every encounter with a patient.
Remember, if it’s not in writing it didn’t happen, says Rossi.

Editor’s note: To read more of Rossi’s advice on a host of different topics check out her monthly’s Director’s Desk Column in CMM. Got a case management question for Rossi or any of our experts? Submit it to Kelly Bilodeau at Kelly@phbphoto.com.

HealthLeaders - Quality and Patient Safety Top Stories

HealthLeaders Media is the original producer of this content.

Infection rates are reduced when physicians are required to wear gloves, according to a study published in the journal Pediatrics. Researchers examined the medical records of children admitted to the same hospital between 2002 and 2010; this hospital required physicians to wear gloves at any time while with patients during the season when the respiratory syncytial virus (RSV) was most rampant.I

Over the course of the period studied, 686 hospital-acquired infections occurred among the patients. According to researchers, the risk of acquiring an infection was 25% lower during times when the hospital mandated that physicians wore gloves. Hospital-acquired infections were 37% lower in pediatric intensive care units, 38% lower in neonatal intensive care units, and 48% lower in the Pediatrics Bone Marrow Transplant Unit when mandatory gloving was in effect. The reduced risk due to glove wearing remained even after researchers accounted for long-term and season trends related to hospital-acquired infections.

Source: Daily RX

The Joint Commission issued a Sentinel Event Alert on April 8 warning hospitals against alarm fatigue caused by medical devices. According to the alert, thousands of alarm signals occur in each hospital unit, each day, and an estimated 85% – 99% of the signals do not require clinical intervention. Clinicians consequently become overwhelmed, as well as desensitized to the sounds, and suffer from alarm fatigue. When clinicians then turn off alarms, reduce the volume, or readjust the settings, patient safety is compromised.

The Joint commission reports that nearly 100 alarm-related events occurred in the period between January 2009 and June 2012. Of these events, 80 resulted in death, 13 in permanent loss of function, and five in unexpected additional care/extended stay.


The 12 steps of the Re-engineered Discharge (RED) toolkit published by the Agency for Healthcare Research and Quality (AHRQ) are effective at reducing readmissions and visits to the emergency department following discharge, according to researchers at Boston University Medical Center. Researchers also updated the set of steps for reducing readmissions, including a new component for overcoming language barriers. RED led to a 30% reduction in hospitalization utilization within 30 days of discharge and a 34% reduction in costs per patient within the same time period, according to researchers.

The 12 actions for reducing readmissions are as follows:

1.     Determine the need for and obtain language assistance

2.     Make appointments for follow-up care, including medical appointments and post-discharge tests

3.     Plan to follow up on results of tests of labs pending at the time of discharge

4.     Organize post-discharge outpatient services and medical equipment

5.     Identify the correct medicines and a plan for the patient to obtain them

6.     Reconcile the discharge plan with national guidelines

7.     Teach a written discharge plan the patient can understand

8.     Educate the patient about his or her diagnosis and medicines

9.     Review options for dealing with problems with the patient

10. Assess the degree of the patient’s understanding of the discharge plan

11. Expedited transmission of the discharge summary to clinicians accepting care of the patient

12. Reinforce the discharge plan via telephone

Source: Fierce Healthcare


Corning Hospital in Elimra, N.Y. is facing a lawsuit from 14 patients claiming they were exposed to unsafe injection practices. The suit also names the hospital’s parent company, Guthrie Healthcare System, along with the nurse who allegedly reused syringes on more than 230 patients. The lawsuit states that the nurse may have exposed patients to hepatitis B, hepatitis C, and HIV over a three-month period between October 2012 and January 2013. The lawsuit was filed on March 25.

In February 2013, Corning Hospital notified 236 people of the mistake and advised them to get precautionary testing. The nurse’s co-workers tipped off the hospital officials, but the hospital is not entirely certain who the nurse is. The public relations manager for the healthcare system notes that they are encouraging all patients who received notification to get testing.

Over the last seven years, the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative (INQRI) has funded 40 studies that show a solid link between nursing care and patient outcomes, identified new areas for research, and identified significant challenges for researchers exploring the way nursing contributes to improve care, according to a press release from RWJF.

A series of articles were put together by interdisciplinary research teams to provide other researchers with the information and insights needed to build on INQRI’s work. The articles review the methodology, findings, and recommendations of several studies. Some of the other findings are as follows:

  • Interdisciplinary research can facilitate the redesign of health systems and health policies to improve care, but healthcare organizations need to make infrastructure changes that facilitate translating the study findings into practice
  • Implementation research lacks set standards and guidelines, and to improve implementation science, researchers need to generate a core set of concepts and metrics, standards for implementation methods, and reporting standards for implementation studies
  • Successful implementation research strategies include educating staff and leaders who have a stake in or will be affected by the study, regular interaction with sites, implementation tools, and raising the visibility of the project

Read more on this study and its findings by clicking here.

CHC in the Spotlight