Recovery Audit Contractors are no doubt a relatively obscure part of the healthcare system, but they can have huge impact on peoples’ lives and well-being. Four private firms run this operation for the federal government to monitor for improper Medicare payments.
Obviously it is in their interest to find things that are wrong. One possibility is the hospitals have coded people as being treated when they are only being “observed,” since reimbursement rates are lower for those on observation status than for those who are “real” patients.
A technical difference, but, as Al Jazeera recently reported, one that mean life or death. For example, those who have only observation status are not eligible for nursing home coverage when they leave the hospital.
The New York Times notes that New York State now has a law that patients must be notified orally and in writing within twenty-four hours if they are put on observation status. So we are seeing a familiar phenomenon: more bureaucracy and costs in the quest for reducing costs!
–Jim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Being semi-retired, Jim is willing to provide very reasonably priced consulting, coaching or project work for organizations aspiring to improvement in organizational culture, effectiveness and employee engagement.
Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium. His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices. Having produced newsletters for several organizations and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as well as consulting and coaching.
www.manage2001.com or email email@example.com