Referral Detective
Three places in the hospital where you should actively look for ARU candidates
Where is ED, ICU, NEURO, TRAUMA, ORTHO, Case Management, Admitting providers, Specialists, etc
"The family wants SNF"
Explore why, educate on ARU benefits and level of care
Discuss length of stay, quality and amount of therapy SNF provides vs ARU, amount of physician and leadership involvement patient has in an ARU setting with PAM Health
Why is your pending list important?
The pending list represents future admissions and helps identify patients needing follow up.
With the increase of commercial and Medicare Replacement plans, authorization turnaround time will keep patients on the pending list. It is important that we educate the CM's to provide the referral in enough time for auth processing.
What does DSC stand for?
Disease Specific Certification
What does the acronym CMS stand for?
Centers for Medicare & Medicaid Services
Three signs a patient may be appropriate for ARU
Hospital of choice has no bed availability
Having choice 1 and choice 2
Highlighting DSC programs
Discuss the short driving distance from one building to the other
???
What is the Market Opening Census
Number of DSCs in the market
4
Stroke
CHF
BI
SCI
Medical need, Therapy need & Rehab potential (Measurable function inprovement)
3 CMS requirements that justify ARU
Next steps when a patient has been in the hospital and only a soft referral was sent by Case Management
What is contact CM to provide verbal approval of patient based on what was proved, request access to complete bedside, provide status update once clinical and bedside eval is reviewed.
**DAILY DOUBLE**
Who won the CEO/VP DIET Challenge
???
Expected ADC to each building?
SAH- 45
NE- 38
WOH- 38
TO- 24
Name the DSC for each hospital
SAH- Stroke, SCI, BI
NE- Stroke
TO-
WOH- Stroke, Heart Failure
What is considered an open MSP on the Medicare Common Working file?
prior or active MVA claim
Prior or active Work Comp Case
Prior or active Liability Claim
Name three patients that are commonly overlooked but could qualify for ARU
Who are patients with Dialysis, Trach, medically complex, debility, transplant, cardiac, oncology
"Insurance probably wont approve"
Let our team complete a bedside evaluation. Based on clinical findings, the admissions dept will initiate the authorization FOR YOU and if needed, will advocate for an approval by submitting an appeal. This is all taken care of by the PAM team.
(be their resource)
30+ referrals
What is the expected number of referrals per day for the market?
**DAILY DOUBLE** Teams have 30 seconds to name out movie quotes to stump Amber.
No answers, just laughs....
What does COB stand for and what does it mean?
Coordination of Benefits-This establishes a primary and a secondary payor to ensure claims are paid correctly.
Both Payors will deny all claims until the patient or MPOA calls each payor to discuss the coordination of benefits.
Your largest referral source has stopped referring. What are your first three actions
Meet with leadership, identify the barrier, re-engage physicians and Case Managers, compose education, & increase rounding
"The patient can't tolerate three hours of therapy"
Internal therapy dept will complete an eval for each discipline and customize a treatment plan based on the patients needs, prior level of function and what the home ADL needs are
You're behind on census midway through the month. What's your recovery plan?
Review your DAR, know what account your down in and when the last referral/admit date was.
Then increase physician engagement, round more frequently in the ER, re-engage key referral sources,
What are the features of a DSC?
Formal structure, evidence-based practice with reported performance measurements
Name 3 of the CMS 13 qualifying Diagnoses
Stroke, Spinal Cord Injury, Cogenital Deformity, Amputation, Major multiple trauma, Fracture of Femur (Hip fx), Brain Injury, Neurological Disorders, Burns, Active Polyarticular Rheumatoid Arthritis, Systemic Vasculidities (Lupus, Scleroderma), Severe Osteoarthritis, Knee or Hip Joint Replacement