As your hospital strives to reduce denial days and length of stay, you might be unknowingly opening your facility up to compliance risks.
As one of the most highly regulated components of case management, discharge planning compliance is vital for effective operations. Unfortunately, understanding the language of the law is confusing and applying the law is a whole battle unto itself.
Comply with federally mandated regulations.
Turn to the second edition of our practical, advice-filled Discharge Planning Guide and CD-ROM set to stay on top of the countless—and always evolving—federal and state regulations that govern the discharge planning process.
From the big picture to the tricky details, we cover it all.
Instead of pondering complicated regulatory language and requirements, with Discharge Planning Guide, Second Edition you'll have instant access to the precise details of how to comply. Authored by renowned discharge planning expert Jackie Birmingham, this book is the first of its kind to offer real strategies and best practices to manage the fine line between moving patients quickly and risking compliance issues. You'll get:
- A quick-access guide discharge planners can use to locate and cite federal standards that will help them write and/or revise their organization's discharge planning policies and procedures
- A quick-access guide discharge planners can use to locate and cite federal standards that defend their decisions regarding continuity of care
- Links to Web sites with more information on compliance issues
- Learning objectives to help guide the learner through the content, as well as act as a training tool
Highlights of what's new!
- Descriptions of changes in the Prospective Payment System (PPS) including information on consolidated billing
- Review of the final rule for Conditions of Participation for discharge planning
- Details about the Post-Acute Transfer rule now applied to 180 DRGs and for patient's Leaving Against Medical Advice
- Information on the many different forms of referrals
- Explanation of the post-hospital extended care benefits
- Discussion of new Medicare Coordination of Benefits program
- Explanation of the confusing 3-day qualifying rule and the 75% rule for inpatient rehab facilities
- Clarification of the patient choice requirement for post-acute care
- Explanation of readmissions and what discharge planners can do to work with home health agencies
Special Q&A Feature!
Added exclusively for Discharge Planning Guide, Second Edition, this new question and answer section, crafted by experienced case management directors with a discussion about the rules that apply to the answers.
Save time and effort with the tools you'll receive on your bonus CD-ROM!
For quick and easy access to important information you need, when you need it, your Discharge Planning Guide, Second Edition comes with a user-friendly CD-ROM. In one central location you'll find critical materials, including:
- Code for federal regulations
- Conditions of Participation (CoP) for the discharge planning process and utilization review
- Assessment of risk factors for hospitalization
- National Guideline Clearninghouse's "Discharge Planning for the Older Adult"
- And much more including tools you can modify to fit your facilities specific needs!
Discharge Planning Guide: Tools for Compliance provides you with the step-by-step solutions and tools you need to tackle the following critical topics:
- What is discharge planning?
- Definition
- Regulatory history
- Discharge Planning: The process
- Casefinding/screening
- Evaluation of the patient's continuing care needs
- Assessment of resources
- Problem identification/ goal setting
- Planning
- Implementation
- Monitoring
- Documentation
- Federal Rules for Discharge Planning
- Three source documents
- Social Security Act
- Conditions of Participation
- Interpretive Guidelines
- List of types of policies and procedures
- Types of Referrals, Transfers, Discharges and Readmissions
- Transfer from acute (acute-to-acute and post-acute transfer rule)
- Referral for post hospital extended care benefit
- Referrals to home health care
- Inpatient transfer to Observation status
- Leaving Against Medical Advice & Patient Elopement
- "Swing Beds"
- Hospice Referral
- Inpatient Rehabilitation Facility
- Home without services
- Issues related to "Readmission"
- Patient Safety, Privacy, Patient's Rights, Freedom of Choice
- Freedom of Choice
- Patient's Rights (including denial and appeal processes)
- Privacy Standards (HIPAA and States)
- Advance Directives
- Special Considerations for Specific Populations
- Limited English Proficiency
- Mandatory Reporting of 'abuse'
- Undocumented Aliens
- Veteran's Administration
- Coordination of Benefits
- Medicare as Secondary Payer
- Worker's Compensation
- Tricare
- Prospective Payment System across the continuum: what discharge planners need to know
- Home Health Resource Groups HHRG
- Skilled Nursing Facility Resource Groups RUGs III
- Inpatient Rehabilitation Facility IRF/DRG
- Consolidated billing" (SNF and Home Care)
- Frequently Asked Questions
About the Author
Jackie Birmingham, RN, MS, CMAC is Vice President of professional Services CuraSpan, Inc. Jackie has over 20 years of experience in discharge planning and case management, and is a noted author and speaker. During this period, Jackie advocated for the need to address care issues across the continuum while serving on a task force for the Joint Commission on Accreditation of Healthcare Organizations.
She also worked with the Health Care Financing Administration during the development of the guidelines for the implementation of the Social Security Act section on Discharge Planning.
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