GoshoJosh

Hey! You certainly did observe a lot! I'm an inpatient RN case manager at a hospital. A little over 2 years of experience & recently became certified with both CCM and ACM. I'll try to answer these questions to the best of my ability - it is important to note that it greatly varies state by state. 1. What are the most difficult insurances to work with? Easiest? How difficult is InterQual(?) when accounting insurance criteria? What do you have to do? In my state, the most difficult insurances are the commercial plans that most people without Medicare (age 65+) have, such as Aetna, Humana, UHC, etc. Commercial plans don't offer very comprehensive home health, SNF, or rehab benefits, which is what many inpatients require upon discharge. Other than that, Human Medicare notoriously denies a lot of services. In the hospital, traditional Medicare (part A) is the easiest to work with. My hospital does use Interqual criteria to help in determining patient status (inpatient vs observation/outpatient). It isn't difficult, but it does take some getting used to. It divides up reasons that people come into the hospital (ex. pneumonia, CVA, infection of various types, DVT, etc) and then provides clinical guidelines that determine whether their condition justifies inpatient status (was the O2 sat 99.4, WBC > 13,000, etc). To try and give an example, if a 67 year-old presents to the ED with fever, cough and imaging reveals pneumonia, that doesn't alone justify an inpatient stay. Imaging has to show PNA in more than one lobe or there needs to be comorbidities that require monitoring. Otherwise, if the ED doesn't document that they are febrile, that they are tachycardic, etc, then they are not meeting Interqual criteria for inpatient status. In that case, the CM discusses with the physician about downgrading to observation because the insurance will most likely deny. Insurance companies are running their own reviews at the same time to determine if they'll pay, so CM is trying to determine this first to avoid denials. Along the same line, it helps CMs determine if a patient can be upgraded from observation to inpatient if they are meeting the criteria (which results in more money for the hospital because inpatient stays get much higher reimbursement from insurance). 2. How do you determine Length of Stay and when to Discharge? Is it mainly by doctor's orders? What is considered sufficient? Do certain insurances require or allow you to a certain length of stay (Ex: Medicare, Humana, Aetna)? CM/SW doesn't determine length of stay. But, there are Medicare established length of stays per diagnosis. It's called a GMLOS: Geometric Length of Stay. The CM would have access to each patient's GMLOS, so they can have conversations with physicians about it. "Hey MD, this patient has a GMLOS of 4 days but they've been here 7 days. Are there any other barriers to their discharge that I can help with?" (like setting up home health, etc). But ultimately the physician is solely responsible for deciding when a patient discharges. Insurances will start to call CMs if a patient has a long length of stay to offer discharge planning assistance, but they can't tell a hospital to discharge a patient. They can, however, threaten to stop paying for the stay if they think a patient should be discharge ready. 3. How do you keep track with the Medicare Rights Message thing every 2 days? How do you keep in track of everything in general? I think you're talking about the IMM: Important Message from Medicare. This is an explanation of rights that a patient has the right to appeal their discharge if they feel like they are being unjustly discharged. Medicare requires that this document is delivered to the patient and signed by them within 48 hours of their discharge. Some CMs give it every 2 days to always be safely in the window, but if you know when your patients are expected to discharge, you technically only have to give it once within 48 hours of their discharge. 4. What is "Obs." and why does it cause CM's to go into a panic/headache when going to "Inpatient?" Obs is observation status. This typically indicates that a patient is being observed overnight and is expected to discharge the next day. If a patient isn't quite sick enough to be considered inpatient, or the workup hasn't revealed a reason to be inpatient, then observation is assigned to them. For example, if someone comes in for a TIA, this is observation status because patients usually recover fully from a TIA. They are placed in obs and then get a full CVA workup. If the MRI reveals the patient did have an acute CVA or hemorrhage, then they will now qualify to convert to inpatient. If not, they are discharged home with TIA education. The reason CMs freak out when trying to convert is that the hospital stands to gain considerably more money from insurance companies if patients meet inpatient criteria. Not to mention inpatients typically have more costs to be treated appropriately, so the inpatient reimbursement rate is necessary. 5. What does "RW, BSC" mean? RW: rolling walker BSC: bedside commode (also called a 3-in-1 commode) 6. Is obtaining the Advance Directive your job or the Social Worker's job? When do you normally have to get it by? In my hospital, advance directives, MPOAs, etc are handled by the chaplain. 7. How do you know when to place a patient in SNF, LTAC, Home Health, Hospice, or Rehab? What example diagnoses would some patients fall under Hospice, SNF, etc? Rehab: most intensive form of inpatient therapy. The patient must be able to participate in 3 hours of therapy daily. Also, a qualifying diagnosis is important (if interested, look up "acute rehab qualifying diagnoses". I think there are 13 currently). LTACH: acute care setting where the focus is not therapy but other medical reasons, like multiple wounds, IV antibiotics, new trachs, etc. These patients require a longer hospitalization but are medically stable because the course of treatment has been established. Home Health: the patient is safe to return home but just needs some support, whether that is a nurse, therapist, SWer, etc. HH usually visits 3-5 times/week. They do NOT do things like caregiving services (no cooking, cleaning, etc) - caregiving services are typically an out-of-pocket expense that insurance does not cover. SNF: lower level of care than LTAC. This is if a patient cannot tolerate 3/hours of therapy a day and is therefore not a rehab candidate, or maybe they just need an interim facility before going home. A SNF patient no longer needs to be in the hospital but often needs a little more support before being able to return home and care for themselves. Hospice: terminal diagnosis from a physician stating that a patient likely has 6 months or less to live. Hospice can be at home, in a SNF, or in a hospital, depending on how sick they are. Comprehensive support, including pain management and palliative care. 8. Who collects "Durable Medical Equipment" or labs? Do you ever place orders for those or do the doctors do it and you get them? CM/SW orders the DME from DME companies. They do need doctors' orders, but we typically enter those orders ourselves as a 'verbal' or 'telephone' read back and the physician signs the order on the backend. This is because we know the correct verbiage that is needed for insurance companies to cover the DME. 9. Who are those Liaison people from different agencies and hospitals? Why are they at the hospital? When do you call them? We call them liaisons too. If someone is going to discharge with home health, home infusions, etc, then that agency will send out a liaison to meet with patient face-to-face in the hospital. This helps the company ensure they have the correct contact info and they also discuss what to expect with their services. 10. Can hospitals replace Durable Medical Equipment if more than 5 years old? Or is that the responsibility of the PCP? Hospitals don't replace DME. The CM or SW orders them from a DME company to be paid for by the insurance. But you are correct, insurance will typically pay for a piece of DME replacement every 5 years.

So I went with UT and turned down Tech. Hopefully that opens up a spot for someone else. Good luck on NCLEX, residencies (I'll be at St Davids), and BSNs, everyone!

Yep, ACC! :)

Yep I graduated on May 7, and we had our ATT's the next Friday May 16. I was told by one of our professors that since our school is in Austin, our paperwork is hand-delivered to the Board of Nursing. I caved and paid the $8 and passed!! Yay!! I start my residency @ St. David's on June 16. Good luck, Jen867, I hope you get it soon!! My AOG showed up May 9 and I had the ATT 7 days later, so yours should appear any day! TexasLVN12, you'll be great! I was not nervous at all until the day before and then it hit me and I felt SO unprepared and almost sick to my stomach. But it wasn't so bad ... the test itself was a blur to me and was over before I knew it. Good luck!!!

I just took the nclex yesterday! I'm getting the 'good' pop-up but can't wait until tomorrow to know if I passed!! Good luck on yours on June 9! Some of my classmates are taking it then.

I got the email today too! I was accepted into this program as well as the University of Texas at Austin program. Decisions decisions! Good luck to everyone waiting to hear back!

Dang. Sorry Brooke!! I've had this M-F 8-5 job for the past two years and haven't really found the time to take off and go to lab. My last day at this position is next Friday (off Thurs for orientation), so I guess I'll have to wait for the first week of school to get my lab practice in before the first check off :-/

Oh dangit! I just checked up on this. I'm working today until 5

Very cool. My lab partner from nursing skills got accepted this round but deferred because she decided she wanted to try for medical school... which is awesome for her but there goes my practice buddy! I don't think allnurses will let me private message anyone because I guess my account is too new. Let me know on here I guess if y'all make any plans to go to lab.

BrookeACC - Since we're both in Hybrid would you like to meet up sometime in the lab and go over our skills? I took Nursing Skills last Fall so it's been close to a year!! I also kinda wanted to get the Grey's srubs because I've seen them in the past and they look more comfortable. But now I guess I'll look into the cargo because that sounds awesome! Let me know if that's something you may want to do :)

Yeah - I would go ahead and start if I were you. I really don't think they'd send you that e-mail if they didn't think they'd be able to fit you in. Plus, the deadline for CPR is Aug 1, which is only a little more than a month away, and there is a finite number of classes available in the Austin area. Maybe wait on the lab pack and scrubs. Also start on the 2-step TB test, since you have to wait 2-3 weeks in between the first and second test and there are only 5 weeks between now and Aug 1. That's just my opinion, though. :) Congrats on the acceptance!

Hey Radiation!! You're currently level 2 or 3 now, right? When you were accepted and did the background check, how long did it take for it to come back/get clearance to register? I did mine last night and I'm sure it'll be done in a few days, but I wonder how long after that it takes for the nursing school to give me clearance to reg. Just curious :)

I received mine as well!! I got hybrid :)

Yeah - I read on the new student orientation page that the background checks are to be done between: STEP ONE: Complete Criminal Background Check (CBC) Implementation Process Incoming Students for Fall 2012 We can only use CBCs from Pre-Check, we do not accept DPS background checks. Background Checks may be ordered between: May 15 - July 15, 2012 Deadline – July 15, 2012 ...but I haven't gotten the e-mail with which campus I'll be at/next steps so I guess it's better to wait... even though we're in that time frame now. I'm just so anxious!

My score was 63.85. Last application round my score was 55.24 and I did not get accepted.. I had a friend who had 56.10 in my nursing skills class last Fall who didn't get accepted immediately but received a late acceptance. So I would agree that the cut-off this round would have been somewhere between 57-59. Too bad we don't get to know what our ranking was. I know I was accepted but I'm still curious! Selfish, I know...