Hospitals Crack Down on ED Repeat Users

Health Leaders Media published an article titled: "Hospitals Crack Down on ED Repeat Users". Key points from the article were as follows:

• Case Manager Plan
• St. Luke's Hospital implemented a plan to identify those who were "frequent fliers" patients who visited the ER 12 times in 12 months.
• Many of these patients go to the ER for various reasons such as: they don't have a family doctor, they lack finances or they may be unable to make their doctor's hours.
• This hospital has estimated that they have saved about a half million dollars by not having to provide additional care and testing for these so-called "frequent fliers"
• Creating a Direct Relationship
• In Massachusetts, many of their "frequent fliers" or as they called them "MVPs" did have primary care physicians.
• The issues that these patients dealt with were more psychological, social and economic issues.
• Following the Care Plan
• Patients receive a letter if they have gone to the ER for more than 12 times.
• They make sure the patient understands the treatment program from their last Emergency Department discharge.
• Technology and Diabetes
• The article stated that in one study 11% of ED visits at two particular hospitals was for diabetic visits.
• They came to the conclusion that patients were not getting the care they needed.
• Behavioral Care and Insurers
• Lack coordination which results in a negative impact on individuals
• Changing Behavior
• The change for these Emergency Departments has shown good results
• No Cure Yet
• Although, improvements have helped at many hospitals, the problems with frequent fliers in the Emergency Department still has a long ways to go.

To download the full article, please click the following link: Hospitals Crack Down on ED Repeat Users

For additional billing and coding resources, please click the following link: Medical Reimbursement Resources Page

Reducing Emergency Department Overuse

Overuse of the Emergency Department for non-urgent or avoidable visits costs the U.S health care system an estimated $38 billion/ year. A Research Brief was published by New England Healthcare Institute Reducing Emergency Department Overuse. The brief covered the following topics:

• Who overuses the ED?
• What are the root causes of the problem?
• What are the consequences of ED Overuse?
• Solutions
• Redesign primary care services
• Telephone Access to After-Hours Consultation
• Extended Practice Hours
• Open Access Scheduling
• Group Visits or Shared Medical Appointments
• Access to Appropriate Services
• Outreach to Primary Care Providers
• Connecting Vulnerable Patients to Appropriate Services
• Provide Alternative Sites of Primary Care for Non-Urgent Conditions
• Urgent Care Services
• Worksite Clinics
• Telemedicine
• Improve Disease Care and Management
• Provide Patient Education
• Offer Patients Financial Incentives
• Increased Co-payments for Non-Urgent Use
• Healthy Rewards Accounts
• Collect Improved Data on ED Use
• ED Census Reports
• Predictive Modeling
• NEHI Recommends the following: 
• Establish collaborative relationships among EDs, primary care providers and community services
• Understand the Patient Population
• Reform payment for primary care services
• Invest in health information technology
• Increase the primary care workforce
• Redesigning primary care services

To view the full study, please click the following link: "Reducing Emergency Department Overuse"

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page

Patient Charges for Top Ten Diagnoses in the Emergency Department

PLOS One published an study titled: "Patient Charges for Top Ten Diagnoses in the Emergency Department".

• The study was conducted to examine charges, variability, payer group for diagnosis & treatment for the 10 most common outpatient conditions in the Emergency Department.
• The study was conducted from a 2006-2008 Medical Expenditure Panel Survey, patients aged 18-64 years of age who had a single discharge diagnosis.
• The study covered 8,303 encounters which represented 76.6 million visits.
• The study concluded that ED charges for common conditions are expensive with high charge variability.
• A few of the top ten diagnoses were the following: Headaches, Sprains and Strains, Upper Respiratory Infection & Back Problems
• The purpose of the study was to allow patients and providers become aware of ED charges that patients may face in the current health care system.

To view the full article with all top ten diagnoses, please click the following link: Patient Charges for Top Ten Diagnoses in the Emergency Department

For addition billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement, Inc. Resources Page.

Electronic Medical Records Probed for Over-Billing

The Center for Public Integrity published an article titled: "Electronic Medical Records Probed for Over-Billing" The article discussed the shift from paper medical records to electronic medical records (EMRs) and concerns with doctors and hospitals billing higher fees.

Key takeaways from the article were:

• Electronic Medical Records (EMRs) may be prompting doctors and hospitals to pay higher fees to Medicare.
• Some software from digital records companies that is marketed to may actually be encouraging the use of elevated billing codes.  
• "Cloning" (cutting and pasting prior encounters for a patient) may also be a cause of problems for the size of the patient's bill.
• According to one testimony, the cloning (copy/paste) method may only be limited to the services documented that were "pertinent" to treating the patient's current medical problem.
• Cloning also may have inaccurate information regarding the patient.
• The Obama administration plans to spend $30 billion dollars in order to help doctors and hospitals 
• Overall, the IT industry agrees that EMRs can lead to higher costs, but EMRs are easier for doctors and hospitals to document all the work they do.

To view the full article, please click here: Electronic Medical Records Probed for Over-Billing

For additional billing and coding resources. please click the following link: Medical Reimbursement, Inc Resources

A Guide to Health Insurance Exchanges

Kaiser Health News published: "A Guide to Health Insurance Exchanges".

• Exchanges: Where consumers can comparison shop for health insurance.
• If everything goes well, exchanges could make the buying process easier for health insurance and may lead to lower prices because of increase competition.
• The exchanges must be set by October 1, 2013.  The exchanges will then go into effect January 1, 2013.
• States have the option of:
• Setting up their own exchanges
• Partnering with Federal government to run an exchange
• Or opt out of the exchanges (when they opt out, the federal government runs the exchange for the state)
• Exchanges will be open to:
• Individuals buying their own coverage
• Employees of firms with 100 or fewer workers (some states 50)
• Most people will be able to get subsidies average of $4,600 per person.
• Undocumented immigrants will be banned from the exchanges.
• Exchanges will be available for residents who earn up to 400% of the poverty level (around $44,600)
• Most people will be required to have coverage by 2014.
• Members of congress will be required to buy from exchanges if they want coverage from the federal government.

To view the full article. please click the following link: A Guide to Health Insurance Exchanges

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources Page

Health Insurance Exchanges Implementation

Kaiser Family Foundation published a fact sheet on "Establishing Health Insurance Exchanges: A Overview of State Efforts".  This fact sheet highlighted the state-based health insurance exchanges (& implementation of these exchanges) which are a key component of the Affordable Care Act (ACA).

• 17 States & Washington DC intend to establish a state-based exchange
• Mississippi's application for state-based exchange was rejected
• 7 States are planning on a partnership exchange
• 26 states will default to federal facilitated exchange
• State-based exchanges must provide access to telephone call centers, build a website with information about insurance options and application assistance and create a Navigator program to improve public awareness and enrollment.
• According to the article, $3.5 billion dollars were distributed to all but 4 states to aid in the funding of the IT infrastructure that is necessary to support the exchanges.
• The fact sheet also has a Figure with "Total Federal Grants for Health Insurance Exchanges" and a Table with "Characteristics of State-Based Exchanges" 

To download the full PDF, please click the following link: Establishing Health Insurance Exchanges: A Overview of State Efforts

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement, Inc. Resources

Health Insurance Exchanges

The Washington Post published an article titled: "Arrival of Insurance Exchanges Raise Questions About Health Coverage in 2014" The article addressed man questions and below are some key takeaways from the article:

• The new insurance policies will have to meet certain standards related to coverage and cost.
• Premiums cannot be more than 3 times higher for older people than it is for younger people.
• Many young people will be eligible for subsidized coverage - through exchanges, their parents insurance or Medicaid. 
• Premium subsidies will be available to people who have incomes at 400% of the poverty level. There are limitations to who can get this as well.  
• If you drop coverage altogether (don't purchase on your own, through an employer or through health care exchange), you will be penalized $95 or 1% of your taxable income.

To read the full article, please click the following link: "Arrival of Insurance Exchanges Raise Questions About Health Coverage in 2014"

For additional billing, coding and reimbursement resources, please click the following link: Medical Reimbursement Resources Page