We have physician advisors, case managers, and utilization review personnel who review patients’ clinical information and follow up appropriately to ensure proper documentation of diagnoses for billing purposes and order of only medically necessary procedures to prevent overbilling (Jackson et al., 2015).
In conclusion, case managers are consistently reviewing charts to ensure that physicians place Medicare patients who meet inpatient criteria on appropriate status, as that would significantly take away or reduce the burden of healthcare costs on patients. The hospital ensures making discharge follow-up calls 2-3 days post-discharge. All arrangements, including transport, were made to ensure patients’ compliance with follow-up visits, reducing the chance of readmission and emergency department utilization. Reducing readmission is a current priority for my health care system, timely outpatient follow-up is promoted as a critical component of transitional care models (Jackson et al., 2015).
References
Hofmann, B.R. (2009). Health care costs. [Electronic resource] : Causes, effects, and control. Nova Science Publishers.
Jackson, C., Shahsahebi, M., Wedlake, T., & DuBard, C. (2015). Timeliness of outpatient follow-up: An evidence-based approach for planning after hospital discharge. Annals of family medicine, 13(2), 115–122.
https://doi.org/10.1370/afm.1753
Norbeck T. B. (2013). Drivers of health care costs. A physician’s foundation white paper – second of a three-part series. Missouri medicine, 110(2), 113–118.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179664/
Simone, J. V. (2011). An analysis of the effects and causes of the high cost of health care. Oncology Times, 33(19), 23-24.
Squires, D.A. (2012). Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. The issue brief, (Commonwealth Fund), 10, 1-14.
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