Patient Criteria and/or 25% Rule Compliance Engagement
Objectives
Assist with pre-admission process and census development opportunities within the Patient Criteria and/or 25% Referral Source threshold
Assess monitoring methods and provide recommendations to improve internal auditing of admissions data
Develop an admissions plan that balances census development within the Patient Criteria and/or 25% threshold to avoid potential payment reductions
Process
Before we arrive on-site we will analyze market data from your acute-care beds and primary and secondary markets to determine the potential volume in your market place by MS-LTC-DRG.
While on-site we will assess your admissions department with interviews and observations of liaison activities and referral outcomes management reports.
We also analyze your outcomes data by referring hospitals to identify risks and opportunities within your current admissions processes.
We will explore opportunities to expand beyond the current market, including evaluating alternative patient populations.
Based on the above observations and analysis, we will develop an admissions plan to effectively manage percent of admissions from your referring hospitals.
Deliverable
Admissions plan, in accordance with the cost-reporting year, to ensure effective management of the Patient Criteria and/or 25% threshold and strategies to improve census while avoiding payment reductions
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