reim1

7/31/22, 9:04 PM Vila Health: Investigating a Readmission

https://media.capella.edu/CourseMedia/bhafpx4009element18870/transcript.asp 1/5

Vila Health ® Activity

Investigating a Readmission

Introduction

A Delay in Payment

The First Visit

Records Check

Conclusion

Introduction You are a reimbursement analyst at St. Anthony Medical Center. Reimbursement for a patient case is overdue, and you’ve been assigned to find out what problems, mistakes, or omissions might have caused the delay.

A Delay in Payment It looks like you have email from Troy Holland, Director of

Patient Services at the hospital. Click on the icon to read it.

Email From: Troy Holland, Director of Patient Services

Subject: Case #1149923

Hi,

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We're having some trouble getting reimbursement on the

above patient case, and I'd like you to look into it and �nd out

what's going on.

The patient presented at the ER last month with symptoms of

tingling sensation in the face, blurred vision, and other

symptoms that suggested an epileptic seizure event. He was

discharged, but 24 hours later, he was back – and this time, he

was diagnosed as having an ischemic stroke.

Can you investigate this? Obviously, we need to get that

payment reconciled, but I'd also like to know if there are any

quality issues regarding the care the patient received that led

to the delay in payment. Let me know if there are, so that we

can get them addressed and keep this from happening again.

Thanks.

Troy

The First Visit A patient presented at the ER with symptoms that indicated an

epileptic seizure. Select each conversation to continue.

Registration Desk Registration Specialist: What's your date of birth, sir?

Patient: September 17, 1957.

["6/17/57" entered into Hospital Records]

Registration Specialist: And do you have insurance?

Patient: Yes, Blue Cross Blue Shield.

[Hospital Records list patient's insurance as "Anthem"]

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Examination Room Doctor: Symptoms include tingling sensation in the face, 'not

feeling good,' confusion, and muscle pain.

Patient: My face feels numb and I can’t see very well.

Doctor: I see that you have a history of epilepsy and seizures. I

think you’ve had an epileptic episode. We’ll make sure you’re on

the right dose of seizure medication, and send you home with

some meds for the muscle pain.

[Medical Device Report: 780.31, Febrile convulsions (simple),

unspeci�ed]

Records Check When you dig into the records for both visits, you �nd the

following information. Investigate the scene to continue.

Letter from Insurer We are the payer for patient 1149923. We have received two

bills for this patient with dates of service that are 24 hours

apart, and we are concerned with the quality of care the

patient received on the �rst visit. As a result we are requesting

medical records from the patient’s �rst and second visits to

your Emergency Room.

Physician Supervisor Yikes. The nurse’s notes say that about 17 hours after

discharge from the ER, the patient returned with a severe

headache, increased slurring in speech, and tingling in his right

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arm.

Physician Whoops. Looks like discharge planning included a 24-hour

follow-up call to make sure the patient scheduled a primary

care visit, but I don’t see any record of that call being made.

Nurse I don’t see any orders for diagnostic testing on the �rst visit,

and it doesn’t look like they even sent him to the observation

unit before sending him home.

Conclusion You have completed the Vila Health: Investigating a Readmission activity.

Delays in reimbursement can be costly for a health care

organization.

Re�ection Questions What problems did you observe that might lead to delays in reimbursement — or even nonreimbursement or �nes?

Your response:

This question has not been answered yet.

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