This week’s updates include revisions to State Operations Manual (SOM), Appendix A -Survey Protocol, Regulations and Interpretive Guidelines for Hospitals; Claim Status Category and Claim Status Codes update; and more!
Regulations adopted in October 2013 allow hospitals to bill Part B for inpatient cases that are internally reviewed and "self-denied" within one year of the date of service. But utilization review staff are unsure when to use the old condition code 44 process and when to opt for the new process using condition code W2. Operationalizing these rules can prove to be challenging, causing recoding, rebilling, and expensive slowdowns in the revenue cycle.
Identify the new audit process that will be used by one of the two quality improvement organizations in charge of short stays under the 2-midnight rule.
As the year rolls to a close and you start to look forward to 2016, it's time to step back, look at your program, and set some goals for next year. Karen Zander, RN, MS, CMAC, FAAN, principal and co-owner of The Center for Case Management in Wellesley, Massachusetts, says it's always a good idea for case managers to stick to tried and true best practices that have been proven effective over time.
Q: When you refer to a laptop being encrypted for security reasons, is that the same as password protected? We have a number of employees with laptops who transport them from work to home and are concerned about a breach if a laptop is stolen.
