Admissions

[CapeCodMermaid, RN]

Here's my question: who in your facility is responsible for admissions? We have a rather cumbersome process. We get a fax from our sister facility about MR X who needs to be screened. That fax goes to the bookkeeper for her to BLAST and find out insurance information. Then the screener goes to the hospital, screens the patient and faxes over the screen. I, as the DNS, give a clinical acceptance or denial. That's my part...I don't pick the room, I don't call the family, I don't do the insurance....

so here is the issue---today we got a call from the hospital saying MRS X was ready for discharge...okay so she comes in...with a guardianship paper and we can't find the guardian! We CAN"T send her back...we have multiple issues with this hospital as it is...so now we have a person who can't sign herself in.

I always have worked with an admissions person who would 'do' the admission after the DNS gave a clinical okay. Frankly I don't know how to find 10 more minutes in my day to do more than I am doing now. We are just starting to get some managed care contracts so our admissions procedure will have to be streamlined.

Can anyone give me some suggestions?My admissions person is an RN but somehow doesn't seem to get the picture yet.

[Talino]

The hospital would not want to keep a patient any day longer when the clinical condition has stabilized and would be more accomodating to the SNF's requisites. If SNFs in the area have to compete for admissions, I guess having good rapport w/ the hosp. discharge planner is essential.

A plus in NY, a PRI is required before admissions to the SNF. It's a modified version of the MDS which captures ADLs, clinical conditions, medications, therapies, diagnosis, etc. during the hospital stay.

In addition, the SNF faxes a list of requirements to the hosp. discharge planner, i.e., DC summary, consultations, MAR/TAR, procedures/labs/xrays, therapy notes, nurses notes, payment source, family contact, etc. When the records are faxed back to Admissions, a well trained Adm clerk (w/ strong billing background) pores over the technical aspects - payment source, insurances, medicare/medicaid eligibility, family contact, etc. She then goes to the Adm nurse, or PPS/MDS coord, DON, or Nsg. supv to review the clinical part. When necessary, the nurse will call the hosp. and speak to a primary nurse or ask the clerk to have the hosp. fax add'l info. Only when the case is too complex that a person physically screens the applicant in the hospital, that is, a nurse. A room is finally assigned after the clerk and nurse concur.

With managed care, I will make sure the billing officer lays out what the each contract entails and keep the PPS coordinator or whoever is responsible in communicating with the contractor abreast and very well informed.

[noc4senuf]

In our facility, my Admissions person is an RN. She receives faxes from the hospital discharge planners with a hosp face sheet, nursing assessment, med sheets, H&P, labs, etc. She reviews all payor sources, diagnoses, meds and related costs. She checks medicare days available and insurance info. She will then offer a room if appropriate. When she is off during the week, our social worker and/or myself complete these tasks. On the weekends, the In-house charge nurse handles this quite well and if they have any questions they call the Admissions nurse or social worker. We admit 24/7.

[achot chavi]

It sounds like a question for your boss. You don't want to be responsible for this. I was once called for an admission at 7pm when I was the only one left in the building from administration (I am an ADON) and as it turns out the CNA accompanying the patient made a 'mistake' and was supposed to go to a different facility (they applied to several and the guardian was checking out which of us was the cheapest as insurance/Medicare etc. was a problem). It's a good thing that I explained to the guardian that I wasn't authorized to admit the patient until I had a guardian present to sign all the necessary papers. After some phone calls I tracked down the guardian. Turns out she hadn't decided yet where to admit the patient and was hoping we'd take her for the night as the hospital discharged her and the guardian didn't want to take care of her or continue paying a private CNA. I informed her our overnight rate and she was furious how we can charge so much (I don't have to tell you what is included- laundry, food, medical care, nursing, etc. etc.) Had I accepted the admission I would have ended up paying for her. Yes I did empathize with the poor patient who I understand was dragged around to other facilities till one took her in for free. Imagine the legal implications of an admission without signatures from the guardian!!!

[CapeCodMermaid, RN]

People never cease to amaze me. We had a man come into the lobby one afternoon with an old lady,presumably his wife, and a suitcase. He sat the woman in a chair, put the suitcase down, and said, "My wife needs a nursing home. I can't take care of her any more", and headed for the door. Luckily I happened to be walking by and stopped him before he could drive away. I explained that we didn't admit people off the street, we needed insurance information, medical information. The poor man was perplexed. I told him to call his wife's doctor and tell him that she needed to go to a facility. He argued with me for a while and finally took the suitcase and his wife out the door.

I've also had discussions with ambulance drivers who try to drop off patients at my facility who haven't been accepted and most likely should be going to the facility in the next town.