Class 1 Hospital Services
Content
Hospital Services
Introduction
The decision to admit is based on complex medical judgment Must be substantiated by a physician’s order
May be based on Severity of the patient’s signs and symptoms Medical predictability of something adverse happening to the patient Need for diagnostic studies that appropriately are outpatient services to assist in determining whether the patient should be admitted Availability of diagnostic procedures at the time when and at the location where the patient presents
Medical Services
Medical services are those services provided to patients who do not required surgery to correct or enhance body functions Are commonly subdivided according to hospital needs for such specific services
Surgical Services
General surgery consists of surgeries to correct conditions in various body systems These services are generally subdivided based on the body systems e.g. cardiothoracic, gastrointestinal, plastic surgery etc.
Rehabilitation Services
Rehabilitation hospitals or hospital units focus in restoring patient function Inpatient rehab. facilities are known as IRF Medicare regulates services which must have substantiated documentation to be medically necessary and reasonably used
Psychiatric Services
Inpatient psychiatric services (IPF) may be independent or free standing or a unit within the acute care facility Medicare reimburses these facilities only for active treatment that improves patients condition
Psychiatric Services
Three criteria must be addressed in IPF patients documentation
Individualized
plan Services expected to improve the condition or for purpose of diagnosis Services supervised and evaluated by a physician
treatment or diagnostic
Ancillary Services
Ancillary services typically included in an inpatient setting are: nursing, radiology, laboratory, physical and occupational therapy, respiratory therapy, dietary counseling, social services, case management etc.
Inpatient Accommodations
We can usually expect a private or semiprivate room, when needed specialty units such as intensive care and newborn nursery In newer facilities or when new units are added we are seeing private rooms more available Special units are equipped to staff specialized care, e.g. coronary care, neonatal, recuperative swing beds
Types of Hospitals
Acute care hospital designated as for-profit or not-for-profit are different only on the basis of ownership status Other types – VA, short term, critical care access which provides care for a specific population, duration, locality and may be reimbursed differently
For Profit
For-profit hospitals are usually owned by corporations whose shareholders own a portion of the business, such as HCA (Hospital Corporation of America) and Tenet health care
Not-for-Profit Hospital
These are typically governed by a board of trustees or directors and do not have shareholders Most not-for-profit hospital are considered to be public hospitals, and are owned by a church, community organization, government agency such as a county
Veterans Hospitals
The federal government established VA hospitals in 1930 Veterans with service connected injuries or disabilities are treated at no cost Other veterans may receive treatment but their insurance company can be billed for treatment of non-service connected conditions
Short-Term Acute Care Hospitals
Short-term acute care hospitals generally provide services to patients recovering from surgery or being treated for acute illnesses or injuries Short-term care is usually considered to be less than 30 days
Critical Access Hospitals
Medicare allows some hospitals exemption from the PPS systems CAH Critical Access Hospital is a small Medicare acute care hospital or clinic or other facility that was a hospital prior to being converted into a clinic
Critical Access Hospitals
CAH facilities must be located more than 35 miles from another hospital The facilities must provide 24 hour emergency services, have an average LOS of no more than 96 hours and be licensed for no more than 25 beds Then CAHs are paid based on a percentage of reasonable cost
Introduction
The decision to admit is based on complex medical judgment Must be substantiated by a physician’s order
May be based on Severity of the patient’s signs and symptoms Medical predictability of something adverse happening to the patient Need for diagnostic studies that appropriately are outpatient services to assist in determining whether the patient should be admitted Availability of diagnostic procedures at the time when and at the location where the patient presents
Medical Services
Medical services are those services provided to patients who do not required surgery to correct or enhance body functions Are commonly subdivided according to hospital needs for such specific services
Surgical Services
General surgery consists of surgeries to correct conditions in various body systems These services are generally subdivided based on the body systems e.g. cardiothoracic, gastrointestinal, plastic surgery etc.
Rehabilitation Services
Rehabilitation hospitals or hospital units focus in restoring patient function Inpatient rehab. facilities are known as IRF Medicare regulates services which must have substantiated documentation to be medically necessary and reasonably used
Psychiatric Services
Inpatient psychiatric services (IPF) may be independent or free standing or a unit within the acute care facility Medicare reimburses these facilities only for active treatment that improves patients condition
Psychiatric Services
Three criteria must be addressed in IPF patients documentation
Individualized
plan Services expected to improve the condition or for purpose of diagnosis Services supervised and evaluated by a physician
treatment or diagnostic
Ancillary Services
Ancillary services typically included in an inpatient setting are: nursing, radiology, laboratory, physical and occupational therapy, respiratory therapy, dietary counseling, social services, case management etc.
Inpatient Accommodations
We can usually expect a private or semiprivate room, when needed specialty units such as intensive care and newborn nursery In newer facilities or when new units are added we are seeing private rooms more available Special units are equipped to staff specialized care, e.g. coronary care, neonatal, recuperative swing beds
Types of Hospitals
Acute care hospital designated as for-profit or not-for-profit are different only on the basis of ownership status Other types – VA, short term, critical care access which provides care for a specific population, duration, locality and may be reimbursed differently
For Profit
For-profit hospitals are usually owned by corporations whose shareholders own a portion of the business, such as HCA (Hospital Corporation of America) and Tenet health care
Not-for-Profit Hospital
These are typically governed by a board of trustees or directors and do not have shareholders Most not-for-profit hospital are considered to be public hospitals, and are owned by a church, community organization, government agency such as a county
Veterans Hospitals
The federal government established VA hospitals in 1930 Veterans with service connected injuries or disabilities are treated at no cost Other veterans may receive treatment but their insurance company can be billed for treatment of non-service connected conditions
Short-Term Acute Care Hospitals
Short-term acute care hospitals generally provide services to patients recovering from surgery or being treated for acute illnesses or injuries Short-term care is usually considered to be less than 30 days
Critical Access Hospitals
Medicare allows some hospitals exemption from the PPS systems CAH Critical Access Hospital is a small Medicare acute care hospital or clinic or other facility that was a hospital prior to being converted into a clinic
Critical Access Hospitals
CAH facilities must be located more than 35 miles from another hospital The facilities must provide 24 hour emergency services, have an average LOS of no more than 96 hours and be licensed for no more than 25 beds Then CAHs are paid based on a percentage of reasonable cost
