In an extraordinary development, Fierce Healthcare is reporting numerous articles where reimbursement is being cut off to hospitals for Non-Emergency visits to their Emergency Departments. Now the primary solution lies in determining if calls are true emergencies (emergent) or non-emergencies (non-emergent) and qualifying those calls. The best way to do that in a tested and proven way is via Decision Support Software (DSS). The best in the business is Odyssey.
For Solution Details Visit: view Odyssey DSS System
Here are excerpts from this related article released today:
February 9, 2012 — 11:54am ET | By Alicia Caramenico Designed to curb the “overuse and abuse” of costly emergency care, Washington’s hospitals will no longer receive Medicaid reimbursement for any “unnecessary” emergency room visits starting April 1, reported The Seattle Times.
In what could be the nation’s most restrictive Medicaid ER policy, the program would stop payment for roughly 500 conditions, ranging from the obviously nonemergent diaper rash to the more complicated hypoglycemic coma and chest pain, the article noted.
Emergency physicians and hospitals would be left to foot the bill for treating those conditions. But providers are urging lawmakers to halt the new policy, noting that Medicaid patients now will have to know what their diagnosis will be before going to the emergency department. “If we don’t know without an X-ray or CT scan, how can they know it?” asked emergency physician Nathan Schlicher, legislative chairman of the Washington Chapter of the American College of Emergency Physicians.
Meanwhile, emergency departments at Utah hospitals are in hot water with the state’s Medicaid program. They have allegedly overbilled Medicaid $22 million for charging emergency rates for non-emergency care between 2008 and 2009, reported The Salt Lake Tribune.
Utah’s Medicaid inspector general has not revealed the hospitals in question and has yet to place some on official notice.
View Original Article on Fierce Healthcare
View related links:
Seattle Times: State Medicaid to quit paying for ER visits deemed unnecessary
Salt Lake Tribune: Most Utah hospitals on hook for overbilling Medicaid