Handling Electronic Submission of Medical Documentation

The Department of Health and Human Services and the Centers for Medicare and Medicaid published a manual on the Process for Handling Electronic Submission of Medical Documentation (esMD)

Overview of the Process for Handling Electronic Submission of Medical Documentation is as follows:

• Centers for Medicaid and Medicare Services (CMS) developed a mechanism to electronically receive medical documentation from providers. 
• This project is called Electronic Submission of Medical Documentation (esMD). 
• Medicare Review Contractors have requested an electronic mechanism to receive imaged medical documentation. 
• Electronic mechanism is used submit imaged medical documentation upon request.

The manual also includes the following submission time frames:

• Prepayment Review Time Frames
• Postpayment Review Time Frames

To download the full article, please click the following link: Electronic Submission of Medical Documentation

Implementation of National Recovery Audit Program

Published by the Centers for Medicare and Medicaid Services: "Implementation of Recovery Auditing At The Centers For Medicare & Medicaid Services", discusses the Medicare Fee-For-Schedule Program

The guide includes the following topics:

• National Recovery Auditing Program - 4 Regions in the United States (A, B, C, & D)
• Medicare FFS Claims Processing
• Improper Payments in the Medicare FFS program
• Medicare FFS Recovery Audit Program Contract Awardees
• Implementation of the FFS National Recovery Audit Program
• Status of the Recovery Audit Program for Medicare Advantage, Medicare Prescription Drug, and Medicaid Programs
• FFS Recovery Audit Review Process
• Key Program Components
• FY 2010 Results
• Corrective Actions
• Continuous Improvement

To view and download the full PDF document, please click the following link: Implementation of Recovery Auditing

How to Handle ED Patients Who Do Not Need To Be Admitted

Do you need a solution on how to handle your Emergency Department patients who do not need to be admitted to the hospital, but are not ready for discharge from the ED?

William Beaumont Hospital in Royal Oak, Michigan implemented a solution that they have found to work well in their emergency department. The solution was titled: "Clinical Decision Unit". This solution was suited for those patients who need to still be monitored without using valuable inpatient space by admitting them to the hospital.

• Guidelines for the Clinical Decision Unit were developed based on best practices from hospitals around the country. 
• The support of physicians and hospital leadership was critical to the success of the Clinical Decision Unit.

The reasons they implemented the Clinical Decision Unit were because of the following:

• The hospital was missing myocardial infarctions (MIs) and admitting patients with chest pain who did not have acute coronary syndrome
• Bed availability was an issue, hospital occupancy rates routinely over 90 percent (where they remain today)
• Lack of bed availability triggered ambulance diversion

To view and download the solution for your emergency department, please click the following link: Clinical Decision Unit

Medicare Overpayment Collection Process

Need information on the Medicare Overpayment Collection Process?

A 3-page fact sheet was developed by the Centers for Medicare and Medicaid Services highlighting the following information about the collection of Medicare physician and supplier overpayments:

• Definition of an overpayment and why the overpayment occurs:
• Duplicate submission of the same service or claim
• Payment to the incorrect payee
• Payment for excluded or medically unnecessary services
• A pattern of furnishing and billing for excessive or non-covered services.
• The Overpayment Collection Process
• The recovery process is used when Medicare discovers an overpayment of $10 or more
• Steps in the Overpayment Collection Process include:
• Demand Letters
• Repayment Plans
• Rebuttals
• Appeals
• Additional Medicare Resources and links

To view and download the fact sheet, please go to the following link: Medicare Overpayment Collection Process (PDF)

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

How to Avoid Ambulance Gridlock

Reducing the amount of gridlock caused by multiple ambulances waiting to transfer patients to hospital care results in a decrease in the amount of treatment wait time and faster turnaround.

An example of a strategy to decrease ambulance gridlock was developed at Valley Hospital Medical Center in Las Vegas, Nevada. The strategy was named "EM Xpress".

Some facts about EM Xpress:

• Simlar to a car racing model comparing the pit crews to the Emergency Department staff
• Reduces the Emergency Department wait time from 19 minutes to under 10 minutes
• Increase of around 75 ambulances a day up from 52 ambulances a day
• Runs from 11am to 11pm

The strategy works in the following way:

1. Bring your patient to Valley Hospital
2. Check-in with the Transfer of Care software
3. Give report to the Charge Nurse or the EM Xpress personnel
4. Offload your patient
5. Done - the Charge Nurse will check you out – drive safely

To download and view the full strategy, please follow this link: How to Avoid Ambulance Gridlock

Other resources are available to assist you at the following link: Medical Reimbursement, Inc. Resources

*We are not affiliated nor endorsed by Valley Hospital Medical Center. The Urgent Matters article is used with permission on our website*

Guide on Medicare Physician Fee Schedule

Need information on the Medicare Physician Fee Schedule?

The Centers for Medicare and Medicaid Services published a short fact sheet on the Medicare Physician Fee Schedule.

The fact sheet covers the following topics:

• Physician services
• 7,400 uniquely covered services
• Therapy services
• Medicare Part B pays for the services of physical therapists, occupational therapists, and speech-language pathologists based on the Medicare PFS.
• Medicare PFS payment rates
• The Medicare PFS is based on the following three components: 
  • 1) Relative Value Units (RVU)
  • 2) Conversion Factor (CF)
  • 3) Geographic Practice Cost Indices (GPCI).
• The Medicare PFS rates formula
• [(Work RVU x Work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)] x CF
• Additional Resources

To view and download the fact sheet, please click the following link: Medicare Physician Fee Schedule

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

How to Streamline Cardiac Care for Heart Attack Patients

A solution created at Memorial Regional Hospital was called "Code Heart" streamlining the cardiac care for heart attack patients in the Emergency Department who required PCI. Some takeaways from the article were the following:

• The purpose of this solution was to: "Eliminate redundancy in treating heart attack patients so patients receive care as quickly and efficiently as possible."
• "Code Heart" eliminated the redundancy in treating heart attack patients with ST-elevation myocardial infarction (STEMI) and the patients now receive care as quickly and efficiently as possible.
• The goal of Code Heart was to ensure that door-to-balloon time in 90 minutes or less.
• With the most current and available data, Memorial met the 90-minute door-to-balloon goal an average of 85 percent of the time.

To view the full article along with the changes that were implemented in the Emergency Department, please visit the following link: Code Heart

*We are not affiliated nor endorsed by Memorial Regional Hospital. The Urgent Matters article is used with permission on our website*