Your hospital has multiple clinics and ancillary services and a primary care physician practice on-site, all of which are owned and controlled by the hospital organization.

Your hospital has multiple clinics and ancillary services and a primary care physician practice on-site, all of which are owned and controlled by the hospital organization. Registration for each of these services takes place at the point of service, and registrars report to the business managers of the clinical areas in which they work. Each clinical area has one registrar, except for the emergency department (ED), which is staffed 24/7 and reports to patient access services. Inpatients and ambulatory surgery patients are registered by patient access services, which maintains staffing from 6 a.m. to 6 p.m. Inpatients admitted during other times are registered in the ED. Patients receiving multiple services undergo multiple registrations, although all registrars have access to the common registration system. Over the past six months, there has been a small but steady increase in patient complaints about registration, centering primarily on the need to undergo multiple registrations. In addition, patient financial services have repeatedly reported registration data collection issues that are not being addressed in the clinical areas.

1. What are the issues described in this scenario and how would you address them?

A patient is calling to complain about a bill that she received from the hospital for her laboratory test on her thyroid function. She states that she has Medicare and that Medicare pays for laboratory tests. Upon review of her account, you see that the diagnosis code attached to the claim is Z00.8 Encounter for other general examination, but you know that Medicare does not pay for specialized exams with only that diagnosis code. Just to be sure, you review the Medicare manual at  https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201510_ICD10.pdf

2.What do you tell the patient, and how could this complaint have been prevented?