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Tuesday, April 29, 2008

Reimbursement criteria going a bit overboard

I had to laugh as my co-worker today told me that he was approached by the lady in charge of double checking charts to make sure we are complying with quality management.

The basic purpose of her job is to make sure that charting is as such that we will be reimbursed for therapy. She also has to make sure that the patient meets criteria for payment.

"Hey Dale," she said, "What is it with all these Q4 breathing treatments being given 10 minutes late or 10 minutes early.

Dale told me he looked at her with a blank face. What was he to say? He told her that we are a busy department, and because this is a job with many interruptions, we have to have some leeway in doing our therapies.

"But," she said, "In order for our insurance to pay, Q4 treatments have to be done every four hours exactly."

Dale said, "At first I thought she was joking, then I realized she was being serious."

What is the medical world coming to. Not only are we incapable of deciding who really needs breathing treatments, we have to do them exactly when we are told.

However, that's not going to happen.


Breathingthroughschool said...

Wow that's pretty brutal! Sorry your insurance won't pay for that, the breathing treatment was given one minute too late.

Glenna said...

Are you kidding me? Then we'd never get reimbursed! We have people going out with 20 pts per round. There's NO WAY they could get done at 4 hours to the minute!

Two words--"IN-SANE!"

Freadom said...

Obviously she read something. But why would we be the only hospital with this stipulation?

This is in no way an official policy, it's only what this one lady said. And, like you say, there's no way -- no way.