Hospital Name Policy Title: EXAMPLE POLICY Observation Services - Carve out of Procedures that Require Active Monitoring The following grid will be used to determine times to be subtracted from the total observation time. Active Monitoring Diagnostic/Therapeutic Services General Radiology CT Ultra Sound Dopplers/Echoes MRI Respiratory Stress Test PT/OT/SP PICC Placements Scopes/Surgical Procedures *Staff should review other ancillary services provided at the hospital that would require Active Monitoring Infusions that require active monitoring: Carved Out Time Time out of room Time out of room; or Actual Infusion Time Staff need to review and determine what infusions will require Active Monitoring: Blood Administration Chemo Dopamine "Drug" "Drug"
Sample Audit Schedule December 31 Fiscal Year End Month January February March April May June July August September October November December Review 12 Month Room and Board Volume Review Volumes for Each Tier 10 Chart Drug Administration Review Observation Emergency Room Scheduled Outpatient 10 Chart Drug Billing Review Correct number of units Correct number of wasted units (JW modifier) Documentation of wasted units 10 Chart Emergency Room Review Provider Procedures Nurse Procedures (CPR, Intubations) Critical Care Documentation Trauma Response Documentation Provider-Based Clinic Volume Review Professional and Facility Visit Volumes Professional Visit Distribution Professional and Facility Procedure Volumes Hospital Cost Report Review Cost to Charge Ratio Review Provider-Based Clinic Medicare Apportionment B-2 Post Step Down Adjustment RHC Cost Report Review Medicare Apportionment percentage FTE Counts Visit Counts 10 Chart Labor & Deliver Review Delivery Charge Volumes Labor Charge Volumes Inventory/Billed Supply Review 10 Chart Observation Review Hour Counts Drug Administration Services Other Billable Services ER Volume Review Professional and Facility Visit Volumes Professional and Facility Visit Distribution Professional and Facility Procedure Volumes o Should be the same o Should be 10% to 15% of visits 11 Month Revenue and Usage Review No Professional Revenues Revenues Mapped to Correct Department
Medicare Apportionment Example Move Costs from Routine to Outpatient Routine Cost 2,000,000 Emergency Room Cost 1,000,000 Total Days 1,000 Emergency Room Charges 1,250,000 Routine Cost per Day 2,000 Emergency Room CCR 0.8000 Medicare Days 800 Medicare Charges 500,000 Medicare Apportionment 0.80 Medicare Apportionment 0.40 Medicare Allowed Cost 1,600,000 Medicare Allowed Cost 400,000 0.80 0.40 Move $100,000 of cost from Med/Surg to the Emergency Room Routine Cost 1,900,000 Emergency Room Cost 1,100,000 Total Days 1,000 Emergency Room Charges 1,250,000 Routine Cost per Day 1,900 Emergency Room CCR 0.8800 Medicare Days 800 Medicare Charges 500,000 Medicare Apportionment 0.80 Medicare Apportionment 0.40 Medicare Allowed Cost 1,520,000 Medicare Allowed Cost 440,000 0.80 0.40 Change -80,000 40,000 Net Change -40,000
Medicare Apportionment Example Move Costs from One Ancillary Department to Another Laboratory Cost 1,000,000 Radiology Cost 2,000,000 Laboratory Charges 2,777,778 Radiology Charges 5,555,556 Laboratory CCR 0.3600 Radiology CCR 0.3600 Medicare Charges 1,800,000 Medicare Charges 2,400,000 Medicare Apportionment 0.65 Medicare Apportionment 0.43 Medicare Allowed Cost 648,000 Medicare Allowed Cost 864,000 0.65 0.43 Move $50,000 in cost from Laboratory to Radiology Laboratory Cost 950,000 Radiology Cost 2,050,000 Laboratory Charges 2,777,778 Radiology Charges 5,555,556 Laboratory CCR 0.3420 Radiology CCR 0.3690 Medicare Charges 1,800,000 Medicare Charges 2,400,000 Medicare Apportionment 0.65 Medicare Apportionment 0.43 Medicare Allowed Cost 615,600 Medicare Allowed Cost 885,600 0.65 0.43 Change -32,400 21,600 Net Change -10,800
00 r1'fortfi 'BitJ tj{om tj{osyita{ 'District EMERGENCY CAP ABILITY REPONSE NOTICE: North Big Horn Hospital believes that you are entitled to make inf01med decisions regarding your medical care. Medical staff, including nurses, mid-level clinicians (e.g. Physician's assistant or nurse practitioner) and physicians are either present or "on call" by telephone at all times. However, a physician or mid-level clinician is not on-site 24 hours per day, 7 ~ays per week. If a medical emergency arises when a physician or mid-level clinician is not on-site, the hospital takes the following steps: 1. A registered nurse will perform an initial assessment. 2. The on-call physician/clinician will be notified. after the initial assessment. 3. The on-call physician/clinician will arrive at the hospital, in accordance with hospital requirement, after notification by the nursing staff. 4. The on-call physician/clinician will decide whether the patient needs to be treated, admitted to the hospital, transferred to another facility, or whether other types of arrangements must be made. ;patie~t Name (printed) Patient Signature Encounter#: MR# -----------~ ---------~ Date of Service : - --- - ------ Date, time, and witness-------------- ---- --- 1115La11e12 Loven; U'yoming 82431 <.Pfi.011e (307)548-5200 Pa:({307)548-5205 www.n6fili.com