RAC determinations and Patient Privacy- A Conundrum?
I was part of a recent discussion regarding a RAC determination. The short version is that RAC sent a letter outlining their decision (with detailed patient information to substantiate their adverse decision) not only to the hospital but the patient as well.
Does it not seem a bit inappropriate to send such correspondence to the patient? My thoughts are that it is the extremely savy and well-educated healthcare consumer that can interpret and understand their Medicare benefits, much less to understand what RAC is or keep up with their ever changing rules. Expanding on this further--the average Medicare recipient will be in the mid 60-ish range. This generation trusts their healthcare provider to make decisions in their field of expertise which is healthcare. It's pretty standard practice for all physicians to work-up a symptom like chest pain or syncope. In addition to the Hippocratic Oath that they all took, let us not forget that this is a litigious society in which we live. This means physicians must practice defensive medicine as well. That being stated, compounded with the fact that medicine is not an exact science nor are two bodies exactly the same-- a physician may not be able to determine the exact cause of symptomology in 24 or 48 hours.
Now changing gears just minimally--revisit the notion of the average, mid 60-ish healthcare consumer who receives such a letter. A letter stating that the hospital payment is being denied for a surgery that took place in 2008 and that while they cut away necrotizing ...what!??... out of the sacrum, it was not enough to substantiate payment. If the said patient was me, I might be a bit befuddled to say the least. I would probably wonder (1) why is my sacrum being discussed in such vivid detail to strangers and how many people are reading this? (2) Isn't that why I signed that piece of paper when I was admitted to the hospital? To protect my personal health information?? (3) Does this mean that this hospital or doctor is below average quality? (4) Honey! Call the lawyer! They cut away my sacral tissue and this company said they didn't cut away enough!
The aggressiveness with which RAC is attacking is dizzying. But Alas! I better not present to the hospital--it will probably be reviewed and denied INPT payment. Then my boss may just very well find out that my head really is just filled with air!
Does it not seem a bit inappropriate to send such correspondence to the patient? My thoughts are that it is the extremely savy and well-educated healthcare consumer that can interpret and understand their Medicare benefits, much less to understand what RAC is or keep up with their ever changing rules. Expanding on this further--the average Medicare recipient will be in the mid 60-ish range. This generation trusts their healthcare provider to make decisions in their field of expertise which is healthcare. It's pretty standard practice for all physicians to work-up a symptom like chest pain or syncope. In addition to the Hippocratic Oath that they all took, let us not forget that this is a litigious society in which we live. This means physicians must practice defensive medicine as well. That being stated, compounded with the fact that medicine is not an exact science nor are two bodies exactly the same-- a physician may not be able to determine the exact cause of symptomology in 24 or 48 hours.
Now changing gears just minimally--revisit the notion of the average, mid 60-ish healthcare consumer who receives such a letter. A letter stating that the hospital payment is being denied for a surgery that took place in 2008 and that while they cut away necrotizing ...what!??... out of the sacrum, it was not enough to substantiate payment. If the said patient was me, I might be a bit befuddled to say the least. I would probably wonder (1) why is my sacrum being discussed in such vivid detail to strangers and how many people are reading this? (2) Isn't that why I signed that piece of paper when I was admitted to the hospital? To protect my personal health information?? (3) Does this mean that this hospital or doctor is below average quality? (4) Honey! Call the lawyer! They cut away my sacral tissue and this company said they didn't cut away enough!
The aggressiveness with which RAC is attacking is dizzying. But Alas! I better not present to the hospital--it will probably be reviewed and denied INPT payment. Then my boss may just very well find out that my head really is just filled with air!