Comments on: I Suppose It’s Better Than Death Panels …

By: SeaSpray

SeaSpray — Fri, 16 Jul 2010 04:30:40 +0000

I definitely think they can’t reward the people denying claims. Total conflict of interest.

These things are so disturbing. And now more and more people are realizing how much the new HC bill is going to hurt them.

I really do not understand how a woman in the hospital for 5 weeks is not considered admitted. It’s like one big game and providers are constantly having to look for ways to out smart mdcr, etc.

By: JustADoc

JustADoc — Tue, 13 Jul 2010 17:29:37 +0000

What if they still need to be in the hospital but still don’t meet admission criteria? While that is a rare occurrence, it does happen.

By: MedITGeek

MedITGeek — Tue, 13 Jul 2010 16:01:28 +0000

And the hospitals that kept those two patients for the extended “observation” stays? They’re SOL because Medicare actually only allows for 72 hours of observation before there is a requirement to either admit or discharge. (AKA, make a committment to a course of treatment.) And if they didn’t tell the patient that everything after that wasn’t covered, they couldn’t bill the patient for it.

Somebody’s care coordination/case management department wasn’t doing their job.

By: Supremacy Claus

Supremacy Claus — Tue, 13 Jul 2010 10:05:40 +0000

The decision to hospitalize is a licensed medical one.

The determination that a hospitalization was not necessary is another, opposing licensed medical decision.

It is done by a unlicensed, non-doctor, that decision represents the unauthorized practice of medicine. The contractor or government official making it should be reported to the state licensing board.

If the denial of payment is done by a licensed doctor, the decision represents unprofessional conduct. The doctor is making a licensed medical decision about a patient he has never met, let alone examined and treated. The doctor should be reported to the state licensing board.

The patient should file a standardized complaint form against the persons involved, every time payment is denied.

The excuse, we are denying payment, not commenting on necessity of care, is a frivolous, pretextual, phony argument. It should be the basis of an additional complaint to the insurance commissioner of the state.

By: paul

paul — Tue, 13 Jul 2010 05:40:52 +0000

all i can say is medicare better have enough money left to give me the scooter i’m entitled to once i hit retirement age.

By: cardioNP

cardioNP — Tue, 13 Jul 2010 04:03:22 +0000

Thanks for that (non)-clarification as to what qualifies as obs. I wondered about that when I got my mother’s Mcare bills after she died. Her last couple hospitalizations were obs status. Tried to get clarification from the hospital, but couldn’t get an answer.
Don’t know if it is true currently or not, but a decade ago when she was admitted on obs status she got billed for all of the meds that were administered in the hospital. That 625 mg of tylenol pre-transfusion was about 10 bucks. If she had known that she was going to be billed for her meds I’m sure she would have taken her own meds. But now I guess that TJC wouldn’t let that happen.

By: christine

christine — Tue, 13 Jul 2010 02:30:52 +0000

I love your blog!!!

But all these politicians are telling me that Medicare is the best thing since sliced bread, how can this be? (note sarcasm).

By: Steve

Steve — Tue, 13 Jul 2010 01:36:01 +0000

The next step which will effect ER doctors will be the downgrading of our own services when admissions are deemed “inappropriate” in retrospect…suddenly that level 5 chart is now a level 3 or 4 even though you spent the time and energy on the workup, calling consultants, etc.

By: ERP

ERP — Tue, 13 Jul 2010 01:29:22 +0000

We admit pt’s to “obs” but then if they stay more than 23 hours they are officially admitted by the PMD after a re-eval. Everyone seems happy.

By: sleepyjosh

sleepyjosh — Tue, 13 Jul 2010 01:21:53 +0000

FWIW–I know that the RACs are going after DME/HHC vendors quite a bit. The office I worked for had a surprise visit from a RAC for this purpose as we often place DME (proper) orders. What the DME vendors do on the other hand, we don’t know (leave that to the RACs to find out).

Though the surprise appearance of the RACs at the office was quite scary.

[Happy ending though, they weren't auditing our physicians--just DME vendors]/