briefCASE
Dec. 31, 2014

Was I out of line to tell a physician about a patient with a history of substance abuse?
Nurse.com
From April 2: According to author Nancy J. Brent: When it comes to patient confidentiality and privacy, the [case manager] has an obligation to protect both. However, the protection of privacy and confidentiality are not absolute. One of the things you may want to consider working into your [case management] practice is to discuss with the patient and family at the onset that there are some things that you cannot keep private and confidential and then give general examples — e.g., child abuse, criminal activity, communicable diseases, past medical history that may affect current treatment — and to whom that information would be shared. More

House members urge HHS to address Medicare appeals backlog
AHA News Now
From May 21: At a recent hearing on oversight of Medicare programs to recapture improper payments, members of the House Committee on Oversight and Government Reform pressed witnesses from the Centers for Medicare & Medicaid Services and Department of Health and Human Services to explain and address the growing backlog of appeals at the administrative law judge level. "I've talked to physicians, hospitals, health care providers and they say the first fair hearing they get is the administrative law side of it," said Rep. Mark Meadows, R-N.C. More

Care transitioning — a patient's vital resource
The Grass Valley Union
From June 18: Although elderly, she had been living alone, enjoying independence with minimal support — until a health crisis made her a patient at Dignity Health Sierra Nevada Memorial Hospital. After discharge, she would need additional help before she could return to her former lifestyle. Making certain that she got that help is the role of the hospital’s team of nurse case managers. More

MedPAC discusses hospital short-stay policy, 340B and site-neutral payments
AHA News Now
From Nov. 12: The Medicare Payment Advisory Commission discussed the option of creating specific Diagnosis-Related Groups for one-day hospital stays in an effort to reduce payment differences between short inpatient and similar outpatient hospital stays. Other related topics of discussion included rebilling for short stays, efforts to alleviate beneficiary concerns related to observation stays, and possible policy changes to the Recovery Audit Contractor auditing process. More

Emergency room doctors struggle with 2-midnight rule, observation status
FierceHealthcare
From July 16: As hospitals across the nation face the complications involved with the two-midnight rule, emergency physicians may experience the most conflicts as they strive to balance patient needs with the federal government requirements for short inpatient stays. Emergency and internal medicine physicians often struggle to get the right designation and status for the patient, said Catherine Polera, M.D., chief clinical officer of the division of emergency medicine at Sheridan Healthcare, a national hospital-based, multispecialty practice management company. "They go through a dance and it's not as clear as you might think," said Polera. More

ALJ chief: Backlog growing
AHA News Now
From July 16: The timeframes for a hearing and deciding of a Medicare appeal by an administrative law judge has steadily increased since fiscal year 2010. The timeframes have increased to 387 days, said Nancy Griswold, chief ALJ from the Department of Health and Human Services' Office of Medicare Hearing and Appeals. Griswold said this to members of the Subcommittee on Energy Policy, Health Care and Entitlements of the House Oversight and Government Reform Committee. More

CMS delays awarding new RAC contracts
AHA News
From July 2: The Centers for Medicare and Medicaid Services has agreed to postpone awarding the new round of Recovery Auditor Contractor contracts until at least Aug. 15 because of pending litigation, according to court documents. CGI, one of the current RACs, has sued CMS in federal court to protest terms of CMS's proposed RAC contracts. CMS came to an agreement with the court to delay the awarding of new contracts while the court moves forward with proceedings in the case. AHA will continue to update members as more information regarding the new round of contracts is available. More

Judge rules against White House on ACA subsidies
Politico
From Oct. 1: A federal judge in Oklahoma has ruled that Obamacare subsidies cannot go to residents of states that are not running their own insurance exchanges, a second blow to the Obama administration on an issue that threatens a key element of the health law's coverage expansion. Judge Ronald A. White said that the administration's decision to allow subsidies to go through either a state-run health insurance exchange or the federal exchange is an improper and invalid reading of the Affordable Care Act and must be struck. More

Lumbar fusion procedures and RAC audits: What you need to know
SpineLine
From Aug. 20: Lumbar fusion procedures are the latest to come under scrutiny from Recovery Audit Contractor (RAC) audits. Currently audits of lumbar fusion procedures are occurring in two of the four federally designated regions, each served by a different RAC contractor. The RAC process will likely have an effect on the documentation requirements and reimbursement for lumbar fusion procedures. More

Flood of pediatric mental health patients strains emergency department
AAP News
From May 28: Over the last decade, there has been a concerning rise in emergency department visits for mental health concerns. Pediatric patients are being referred to the ED by mental health providers, schools and pediatricians, and many are brought by family members. Between the late 1990s and last year, such visits to the Connecticut Children's Medical Center ED skyrocketed from 400 to 2,500 annual visits. More