Tift Regional Medical Center is part of a nonprofit health system that serves 12 counties in South Central Georgia. The 191-bed medical center, a regional referral hospital that serves as the system’s main campus, has been ranked as one of the top 10 medium-sized hospitals in the state.
When the two-midnight rule was published, Xtend was already working with TRMC to implement a medical record review process for short-stay patients to ensure appropriate documentation and billing. After reviewing the new rule, Xtend and the TRMC team concluded that compliance would require changes in several of the hospital’s clinical processes. In revising the processes for documentation into electronic medical records, the team included physicians, case managers, and utilization review staff in the same explanatory process of the rule and in the plan to meet the changed requirements for inpatients.
Xtend compliance experts consulted with TRMC’s patient financial services staff to help them understand the rule’s instructions for conserving the time a patient had already received service in an outpatient area (e.g., emergency or diagnostic services.)
Xtend also coordinated training for patient care manager, who, under the new rule, would have to switch from long-established clinical assessment tools to an approach that depended on the physician’s evaluation and plan for the patient that indicated the need for care beyond the two-midnights threshold. A web-ex session with the patient care management team helped educate them about documentation requirements for an inpatient admission under the new rule and showed them various examples of regulatory-compliant accounting of the time that patients received outpatient care before physicians issue orders for inpatient admission.