2-Midnight Rule: Medicare's New 2013 Inpatient Hospital Payment Policy Explained (CMS 1599-P).
Hospitalists have risen to the challenge of only providing medically reasonable and necessary inpatient hospital care under the rules of three-midnight medicine. They have refused to delay patient discharges just so patients could enjoy high quality care in the nursing home of their choice that is paid for by our Medicare National Bank. They are willing to accept discharge to home and face the music of bad patient satisfaction survey scores filled out by angry family members who are upset their hospitalist wouldn't commit Medicare fraud to get grandma to a Medicare paid nursing home for the next...
Source: The Happy Hospitalist - May 6, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Medicaid Pay Increase For Hospitalists Confirmed For 2013-2014.
Are hospitalists going to get a Medicaid pay raise for 2013 and 2014? The answer is yes, hospitalists qualify for Medicaid parity (with Medicare) as required by the Affordable Care Act (ACA). For many states, Medicaid pays physicians and other providers a fraction of Medicare rates. Legislation signed as part of the ACA mandates Medicaid rates to equal 100% of Part B Medicare rates in calendar year (CY) 2013 and 2014. That means if you haven't already seen increased rates, and you are a qualified physician providing qualfied primary care services, you will get increased Medicaid payments retro...
Source: The Happy Hospitalist - April 24, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Medicaid Pay Increase For Hospitalists Confirmed For 2013-2014: ACA Rules We Are Qualified Primary Care Providers.
Are hospitalists going to get a Medicaid pay raise for 2013 and 2014? The answer is yes, hospitalists qualify for Medicaid parity (with Medicare) as required by the Affordable Care Act (ACA). For many states, Medicaid pays physicians and other providers a small fraction of Medicare rates. Legislation signed as part of the ACA mandates Medicaid rates to equal 100% of Part B Medicare rates in calendar year (CY) 2013 and 2014. That means if you haven't already seen increased rates, and you are a qualified physician providing qualfied primary care services, you will get increased Medicaid payments...
Source: The Happy Hospitalist - April 24, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Place of Service (POS) CMS List Coding Instructions Revised (CR7631).
Every physician or other provider encounter requires a place of service (POS) code for proper claims processing. But how should a physician determine their point of service? The Centers for Medicare and Medicaid Services (CMS) put an end to that question once and for all with Change Request 7631. Apparently, there have been too many errors over too many years with physicians and other providers reporting the wrong site of service location.
As far as I can tell, this Change Request 7631 was originally submitted March 29th, 2012 under Transmittal 2435 in the CMS Manual System. Transmittal 2435...
Source: The Happy Hospitalist - April 17, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Hospital Patient Chart Dropped = More Work For Nurses.
If I drop a patient's hospital chart, I would never expect someone else to put it back together. I dropped it. I put it back together. I expect the same if I drop a cup of coffee all over the computers at the nurses station. I spilled the coffee, I clean it up. That's just my perspective. That's why I'm surprised to see some nurses come to the rescue of the poor helpless doctor who dropped the patient's chart. "I can clean that up for you", they say. "Just leave it and I will put it back together", say other clerks and nurses. It's almost as if there is a class in nurs...
Source: The Happy Hospitalist - April 3, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Doctors Accepting Medicaid? facebook Says There Are None (Picture).
Citizens who claim Obamacare is a major victory for patients are going to be greatly disappointed to learn that Obamacare promises to provide health care insurance without health care access. Obamacare promises to massively expand Medicaid. Medicaid is broke. The only places accepting Medicaid these days are hospitals and emergency rooms. I have been a practicing hospitalist now for ten years. I have seen Medicaid failures first hand. In my community of Lincoln, NE, finding a new doctor to accept Medicaid is nearly impossible. In fact, I have witnessed first hand how difficult it i...
Source: The Happy Hospitalist - March 29, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Medical Chart Review Sign As A Marker of Prognosis.
As a hospitalist, I can say with confidence that taking care of an elderly patient with volumes of medical records is easier than taking care of a young patient with volumes of medical charts to review. I find the medical conditions, the psychosocial issues, the family relationships and the complexity of the medical plan much easier to navigate for our elderly sick than for our young sick population. In general, I find the coping mechanisms of our young and chronically ill patients to be more difficult for health care providers to navigate. Perhaps that has to do with a level of immaturity that only expe...
Source: The Happy Hospitalist - March 28, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Drug Therapy Requiring Intensive Monitoring For Toxicity (List) For High Risk Medical Decision Making (MDM) in E/M Explained.
In addition to history and physical, determining the level of medical decision making (MDM) is necessary to define which CPT® code to correctly submit for payment. The American Medical Association's CPT® manual is the authoritative reference for all CPT® related questions and should be available for all physicians to quickly reference. Evaluation and management (E/M) rules are complex and are often open to interpretation, including the high risk MDM component of "drug therapy requiring intensive monitoring for toxicity". The same data presented to different coding experts or auditors will invaria...
Source: The Happy Hospitalist - March 21, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Drug Therapy Requiring Intensive Monitoring For Toxicity (List) For High Risk Medical Decision Making (MDM) in E/M Explained.
In addition to history and physical, determining the level of medical decision making (MDM) is necessary to define which CPT ® code to correctly submit for payment. The American Medical Association's CPT ® manual is the authoritative reference for all CPT® related questions and should be available for all physicians to quickly reference. Evaluation and management (E/M) rules are complex and are often open to interpretation, including the high risk MDM component of "drug therapy requiring intensive monitoring for toxicity". The same data presented to different coding experts or auditors will invariabl...
Source: The Happy Hospitalist - March 21, 2013 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs
PCA Morphine Dosage Protocol For Severe Pain Management In the Hospital.
PCA morphine is a common method used to achieve pain control in the hospital setting. PCA stands for patient controlled analgesia. This therapy usually involves intravenous opiate therapy. Intravenous opiate management should be taken seriously by hospital nurses and doctors as too much medication can result in a life threatening iatrogenic drug overdose. In most situations, patients will respond rapidly to Narcan, the antidote in opiate overdoses. This complication happens everyday in the hospital, even during optimal monitoring conditions. Many foreseeable and unforeseeable variables a...
Source: The Happy Hospitalist - March 18, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Do Not Incubate The Patient, Please.
Every patient that gets admitted to a hospital is, by default, a full code. That means if their heart stops beating or their lungs stop breathing, emergency resuscitation teams will rush in to save 98 year old grandma who wants every thing done. "Of course, why wouldn't she?" Grandma hasn't been in the upright position for 3 years, but somehow, doing CPR and cracking all her ribs in a horrifying assault is considered standard of care to be demanded by families who need grandma's social security check to make their boat payment every month.
On the other hand, some patients and families understand the lim...
Source: The Happy Hospitalist - March 15, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
iPotty For Kids Inspires iCommode For Adults. Get iPoop Out In iStyle.
We definitely live in interesting times. Only in America, and on Amazon, can you buy an iPotty chair for your potty training baby. Yes folks, you heard that right. It's an iPotty and it's for real! Is your child already addicted to your hundreds of free baby apps you loaded up just for them (and you)? Do they cry every time you turn off Micky Mouse Club House for some digital free entertainment with your Sam's Club grocery box? Do they scream and shout at the thought of going to sleep without the soothing sounds of Daniel Tiger's Neighborhood echoing throughout your home? Then ask ...
Source: The Happy Hospitalist - March 14, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
iPotty For Kids Inspires iCommode For Adults. Get Your iPoop Out In iStool Style
We definitely live in interesting times. Only in America, and on Amazon, can you buy an iPotty chair for your potty training baby. Yes folks, you heard that right. It's an iPotty and it's for real! Is your child already addicted to your hundreds of free baby apps you loaded up just for them (and you)? Do they cry every time you turn off Micky Mouse Club House for some digital free entertainment with your Sam's Club grocery box? Do they scream and shout at the thought of going to sleep without the soothing sounds of Daniel Tiger's Neighborhood echoing throughout your home? Then ask ...
Source: The Happy Hospitalist - March 14, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Daily Weight Fluctuations In the Hospital Explained Away As Magical.
After ten years as a practicing clinical hospitalist, I have settled on the only rational conclusion I can think of regarding unexplainable daily weight fluctuations in the hospital: Many nurses and nurses' aides are part-time magicians. That's right folks. After seeing hundreds of patients over the years experience radical increases or decreases in their daily weight measurement despite negative ins-and-outs, I have no other rational conclusion but to assume many nurses and aides are incredible magicians just waiting to get their big break in the up-and-coming genre of hospital magic.
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Source: The Happy Hospitalist - March 14, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
