...The main difference between inpatient and outpatient services is that inpatient care is performed by an inpatient facility that is prepared for patients to be able to stay overnight if need be. This inpatient care can be provided by a hospital, skilled nursing facility, or a long term care facility. A skilled nursing facility (SNF) is designed to provide rehabilitation services and/or skilled nursing to injured patients after they no longer need to be in a hospital setting. The skilled nurses help the patient and assist with their recovery. A skilled nursing facility is operated by licensed nurses, with the assistance of a medical physician. A nursing home is an example of a long-term care facility, which provides custodial care for patients who suffer from chronic disabilities or prolonged illnesses. Outpatient care, is also referred to as ambulatory care, is somewhat different from inpatient care in a hospital or skilled nursing facility setting. Outpatient care involves care that does not require and overnight stay. This kind of care is found in a family physician office, ER visit, physical, speech or occupational therapy, and home health care. Inpatient coding requires coding of services of each day of the hospital stay thus making is more and more difficult if the hospital stay becomes longer and longer. For procedural coding in outpatient CPT codes are used whereas in inpatient coding ICD procedure are used. In outpatient coding diagnosis like suspected, probable...
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... Beta-blocker drugs, adrenergic, aspirin |Outpatient: Cardiologist office and home. |Angioplasty or even open heart surgery. |In patient: hospital. |Healthy eating, exercise, knowing family history, have annual cardiac screening done. |Outpatient: home, gym. | |2. Cancer |Radiation therapy, chemo therapy, Nutritional therapy. |Inpatient/outpatient: Hospital or Radiation outpatient clinics. |Tumor embolization, tumor removal, mastectomy, Surgical removal of infected organ or body part. |Inpatient: Hospital |Nutrition, don’t smoke, avoid prolonged times to sun, minimize red meat intake, know your family hx, have annual cancer screenings. |Outpatient: Home. | |3. Stroke (cerebrovascular diseases) |Ischemic: Clot-busting drugs immediately. Aspirin, warfarin, speech therapy, physical therapy. TIA stroke: very difficult to manage, attempt to control high blood pressure, reduce brain swelling. |Inpatient/outpatient: Hospital, rehabilitation center. |Carotid Endarterectomy, angioplasty, stent placement. |Inpatient: Hospital. |Avoid smoking and excessive alcohol consumption, exercise, and minimize foods with much fat, healthy eating overall. |Outpatient: Home, gym, support group organizations. | |4. Chronic lower respiratory diseases |Hot fluids: thin mucus in lungs. Have patient cough: excrete mucus from lungs. Echinacea, zinc. |Outpatient: Doctors office or at home. |If lungs affected severely: Lung Transplant |Inpatient: Hospital |Flu shot, pneumocal shot, immunizations,...
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...overnight inpatient stay of one or more nights in many routine cases are no longer required. Today, “non-emergency procedures undertaken during the period of a normal working day (not exceeding 12 hours)” is the standard…the increase of day surgery was driven by innovations in surgical and anesthetic techniques” available for the first time because of technology.(Gilliard, Eggli & Halfon, 2006, p.2). Ambulatory care facilities or outpatient facilities where patients can receive surgical procedures and treatments with little or no recovery required allows patients to go...
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...The inpatient and outpatient hospital services are two totally different processes that are used in the medical facilities or practices at different timing. The major differences between inpatient and outpatient hospital services are the type of services they provide, the coding, and billing process. With the inpatient care patients are required to be admitted in a hospital or to stay overnight. Inpatient care can be provided to patients through skilled nursing facilities, which includes care given by licensed nurses under direction of a physician, such as intravenous injections, tube feeding, and changing sterile dressings on a wound. Then you have the long-term care facilities, such as nursing home that custodial care for patients with chronic disabilities and prolonged illnesses. Outpatient care, which can be provided in hospital emergency rooms or departments are the most common facilities we hear of. Outpatient care covers all types of health services that do not require the patient to stay overnight in the hospital. Outpatient departments provide services such as same-day surgery, where surgeries are performed and the patient does not have to stay overnight or be admitted in the hospital. Then you have home health care services, such as physical therapy or skilled nursing care that could be provided at a patient home. You have care services, such as skilled nursing, physical therapy, occupational therapy, speech therapy, and care by home health aides that is considered...
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...Pros: 1) Days cash on hand was 66.87 in 2012 and it dropped in 2013. This is better because they are potentially paying off debt and there is no need to just keep money sitting. 2) Liquidity is better and this means they are being proactive and managing their money. 3) Outpatient visits are going up each year they are still bringing in revenue. 4) ROE is lower than the quartile, but is still within the median. 5) Use of long-term debt has increased meaning they are paying that off a little at a time. Cons: 1) Total Margin was 8.75% in 2011 which is higher than the +Quartile at 5.5%. This could put them in debt is a competitor comes along because they could come in with lower rates putting them out od business. 2) Profit per outpatient visit was really low in 2011 at 33.07, but has been increasing every year and significantly from 2012-2013. 3) Length of stay is going down making more beds available, This will yield our rates. 4) Staffing was too high, our turnover rate is higher. We are spending way too much time on each patient and this could also be inefficient time spent. 5) Expenses are going up! Our bad debt is higher than the industry and this could mean that we are doing more write-offs. Question 2 5 financial KPIs to be presented at future board meetings: 1. Days cash on hand Our days cash on hand is better than the industry average, but declined drastically from 2012 to 2013. This means that we used far more cash than we generated last year. If we...
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...Differences and Importance of IPPS, OPPS, MPFS and DMEPOS The inpatient prospective payment system (IPPS) is a payment system that includes the cases of diagnosis-related groups (DRGs) as acute care hospital inpatients. It is based on resources that are used to treat Medicare recipients in those groups. Each DRG has a payment weight assigned to it, based on the average cost of treating patients in that DRG. IPPS plays an important role in deciding all hospital costs including the costs of all devices for treating the patient during a particular inpatient stay (CMS. Gov, 2012). On the other side, the outpatient prospective payment system (OPPS) is regulated for different outpatient service groups as ambulatory payment classifications (APCs). Outpatient services in each APC are similar in terms of clinical aspects and required resources. In addition, the APC payment rate for each group is wage adjusted to justify geographic differences and applied to all services in the group. In this, hospitals get a fixed amount for all outpatient services based on ambulatory payment classifications. Apart from this, Medicare uses it to reimburse physicians and other health care providers for the services and items that are not part of prospective payment systems (Herbert, 2012). A medicare physician fee schedule (MPFS) determines the payment rates for physician and therapy services that are based on relative value units, conversion factors and geographic practice cost indices. ...
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...Inpatient Care & Ambulatory Care I will discuss and compares inpatients care and ambulatory care on bases of scope and level of service, venues for care deliver, impact on health care finance, and future trends in medicine and care delivery. The term inpatient refers to a patient staying overnight in a health care facility, such as a hospital or a nursing care facility.Outpatient refers to services provided while the patient is not lodged in the hospital or some other health care institution.There are direct personal involvement within the level of services in the practice of ambulatory /outpatient services which detect,prevent disease such as hypertensions, diabetes , cancer screening and immunization programs. Since death happened and caused by disease that are contagious , primary prevention lesson the danger of morbidity are enforced by encouraging people to wear seat belt, clean treatment for water/sewage and sanitation inspections in restaurants. One method of ambulatory/outpatient service is that clinician would travel from house to house to skilled practitioners in relatively more complex facilities is a form of medical care. Ambulatory/outpatient can be distinguished in the following categories: Primary care help to control costs, utilization and the rational allocation of resources.and serve as patient advisor , advocate, and system gatekeeper, gives advice regarding to diagnoses, therapies and provides care for chronic conditions. Secondary care on...
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...strike-thru) Two-Midnight Rule CMS adopted the Two-Midnight rule for admissions beginning on or after October 1, 2013. The rule states: Inpatient admissions will generally be payable under Part A if the admitting practitioner documents the patient to require a hospital stay that is expected to cross two midnights, and the medical record supports that reasonable expectation. Medicare Part A payment is generally not appropriate for hospital stays (acute, LTAC, and psychiatric) not expected to span at least two midnights. Purpose Because of the structure of Medicare, payment for hospital services is distributed differently for inpatient status versus outpatient status. When a patient is admitted to a hospital as an Inpatient, the reimbursement falls under the Inpatient Prospective Payment System (IPPS). In contrast, when a patient is admitted to the hospital as Observation, Medicare pays the hospital under the Outpatient Prospective Payment System (OPPS). The care provided is the same regardless of the Inpatient or Observation status assigned. The doctor must decide whether it is suitable to admit the patient as an Inpatient or Outpatient based on the 2 MN Rule criteria provided by CMS. The beneficiary is responsible for a one-time deductible if admitted (and billed) as Inpatient, but conversely will be responsible for a copayment on each individual hospital service if admitted (and billed) as Observation. CMS states the rule was introduced to provide greater clarity to the physicians...
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...------------------------------------------------- Q1.What factors contributed to the growth and decline of the number of the hospitals and hospital based services? which of these factors do you think is most significant and why? * ------------------------------------------------- * ------------------------------------------------- Ans: Factors contributed to the growth of hospitals are as follows:-- * ------------------------------------------------- 1.In 1946 Congress passed The Hill Burton hospital contruction Act to fund the expansion of the hospital system to achieve the goal of 4.5 beds per 1000 persons. * ------------------------------------------------- 2. A rapid population burst in the 60s and 70s,increased the requirement for more hospitals. * ------------------------------------------------- 3.Also a rapid increase in technology required hospitals to be more equipped for which different sections were created in hospitals and hence more hospitals were needed * ------------------------------------------------- * ------------------------------------------------- I think population factor played main role for the increase of the hospitals because “more people,more hospitals are required” * ------------------------------------------------- * ------------------------------------------------- Factors contributed to the decline of the number of the hospitals :-- * ------------------------------------------------- 1.In 1980s medicals advances and cost...
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...09/06/2012 The clinical practice of psychiatric nursing can occur within an inpatient or outpatient setting. Registered nurses work with individuals, families, groups, and communities; assessing mental health needs, developing diagnoses, plan, implement, and evaluate nursing care. They deal with nursing practices characterized by interventions that promote and foster health, assess dysfunction, assist clients to regain or improve their coping abilities, and prevent further disability. These interventions focus on psychiatric-mental health clients and include health promotion, preventative management, assisting client with self-care activities, administering and monitoring treatment regimens, health education including but not limited to psychoeducation crisis intervention, counseling and case management. This specialty of nursing is one that cares for people of all ages with mental illness or mental distress, such as; Schizophrenia, bipolar disorder, psychosis, depression, and dementia. In the inpatient setting, the patient population mainly consists of those patients who will benefit more from a structured, safe, and supervised environment with a direct care approach. The RN’s in the inpatient setting are not only involved in care planning, scheduling, and charting, they are constantly supervising, dealing with medication administration, and performing health checks. Outpatient services are provided to those individuals who may be better served by remaining in their home...
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...codes can create an impact on hospital reimbursement and patient care. Therefore, as the coding supervisor of the University Hospital, I have been asked to merge the inpatient coding specialist job and outpatient coding specialist job into one job position. During this process, I am going to create a new job title and select two job analysis tools on collected data within the two current positions. Creative Job Title: Registered Coding Specialist III Explanation of New Job Title After some research, I have decided on the new job title name to be called, “Registered Coding Specialist III”. As you can see, I decided to remove inpatient and outpatient from the job title and replaced it with “registered” and added “III” to the end. Personally, I feel that the word “registered” provides the meaning of an employee having a higher level of certified knowledge. Therefore, this new job position will require the employees to expand on their knowledge for both inpatient and outpatient coding....
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...Chapter 7: Outpatient Services and Primary Care Ambulatory care Outpatient services, including (1) care rendered to patients who come to physicians’ offices, outpatient departments of hospitals, and health centers to receive care; (2) outpatient services intended to serve the surrounding community (community medicine); and (3) certain services that are transported to the patient. Community-oriented primary care Health care that incorporates the elements of good primary care delivery and adds a population-based approach to identifying and addressing community health problems. Complementary and alternative medicine The broad domain of all health care resources other than those intrinsic to biomedicine. Gatekeeping The use of primary care physicians to coordinate health care services needed by an enrollee in a managed care plan. Hospice A cluster of special services for dying persons (those with a life expectancy of six months or less), which blends medical, spiritual, legal, financial, and family-support services. The venue can vary from a specialized facility to a nursing home to the patient’s own home. Medical home Patient-centered care based on the principles of the Chronic Care Model-that is, use of evidence-based guidelines, application of appropriate health information technology, and use of “best practices”-that seeks to consistently and reliably meet the needs of patients while being accountable for the quality and value of care provided. Outpatient Services...
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...Overview HealthSouth Corporation is one largest rehabilitation healthcare providers. Healthsouth was founded in 1983 and the companies headquarters in Birmingham, Alabama. The company has hospitals in 27 states throughout the United States and in Puerto Rico. They employ 22,000 team members. Healthsouth primarily operates inpatient rehabilitation hospitals and long-term acute care hospitals. Their hospitals provide treatment on both an inpatient and outpatient basis. The inpatient rehabilitation hospitals offer services to patients who require institutional rehabilitation care, and patient care is provided by nursing and therapy staff as directed by a physician order. HealthSouth’s hospitals provide a higher level of rehabilitative care to patients who are recovering from conditions such as stroke and other neurological disorders, orthopedic, cardiac and pulmonary conditions, brain and spinal cord injury, and amputations. Healthsouth strives to return patients to full strength in less time. The company operates 97 inpatient rehabilitation hospitals, including 68 owned hospitals and 29 jointly owned hospitals; 6 freestanding long-term acute care hospitals; 32 outpatient rehabilitation satellite clinics; 25 licensed hospital-based home health agencies; and managed 4 inpatient rehabilitation units through management contracts. HealthSouth was involved in a corporate accounting scandal in which its Chief Executive Officer, Richard M. Scrushy, was accused of directing...
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...Inpatient Outpatient Hospital Care Inpatient Hospitalization To Ambulatory Care Services (2010) from the Researchomatic. Retrieved on 09/05 , 2014 noted ambulatory care Sensitive situation are those "for which good outpatient care can possibly avert the need for hospitalization, or for which early intervention can avert difficulties or more critical disease" Although hospitalization rates are leveraged by socioeconomic components for example scarcity . I will discuss and compares inpatients care and ambulatory care on bases of scope and level of service, venues for care deliver, impact o health care finance, and future trends in medicine and care delivery. There are direct personal involvement within the level of services in the practice of ambulatory /outpatient services which detect/ prevent disease such as hypertensions, diabetes , cancer -screening and immunization programs. Since death happened and caused by disease that are contagious , primary prevention lessen the danger of morbidity are enforced by encouraging people to Utilization An inpatient day (also referred to as a patient day or a hospital day) is a night spent in the hospital by a patient. The a verage number of days a patient spends in the hospital is called the average length of stay (ALOS). The total number of inpatient days incurred by a population o ver a gi ven period of time is referred to as days of care. Mathematically, days of care = number of discharges × ALOS National data...
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...The Krona Community Hospital, established in 1977, is a 60-bed, acute care hospital located in Banconota County. They currently offer a full range of health care services and maintain a staff of almost 100 physicians and specialists, 400 employees, as well as numerous volunteers. They are currently fully accredited by The Joint Commission. A private, not-for profit health care chain called Nouveau Health has taken over the management of Krona Hospital. The new facility that has been proposed to the state officials for approval, will include 74 acute care beds, all of which will be private. It will also include four observation rooms, four surgical operating rooms, a 24-hour emergency center, a maternity department including one C-section room and an intensive care unit. It will also have extensive support services such as physical therapy and cardiac rehabilitation. In order for the new facility to be a success, we must prepare next year’s financial plan and operational budget. This can be accomplished through careful planning, forecasting, and finance management. First, we need to expand the budget and take into consideration any new services being offered. We have $3 million we can use for additional staff, maintenance and other services. Funding sources The primary source of funding is through government health insurance programs. Medicare is the largest source of funding and makes up approximately 40% of the total funding for health care facilities. A second...
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