Loa Days: Impacting Hospital Statistics And Performance

Hospitals may place a patient on a Leave of Absence (LOA) when readmission is expected and the patient does not require hospital-level care during the interim period. LOA days are added to discharge days, but not to inpatient service days (IPSDs). Hospitals should adjust an original claim generated by an original stay when a patient is discharged/transferred from an acute care Prospective Payment System (PPS) hospital and is readmitted to the same acute care PPS hospital on the same day for symptoms related to the prior stay's medical condition.

LOA days are added to discharge days

In the context of hospitals, LOA stands for Leave of Absence. Hospitals may place a patient on a LOA when readmission is expected and the patient does not require hospital-level care during the interim period. For example, when surgery cannot be scheduled immediately.

In terms of billing, LOA is not considered two separate admissions, so only one bill and one Diagnosis Related Group (DRG) payment is made. Hospitals should adjust an original claim generated by an original stay when a patient is discharged/transferred from an acute care PPS hospital and is readmitted to the same acute care PPS hospital on the same day for symptoms related to the prior stay's medical condition.

Discharge, on the other hand, occurs when a patient no longer needs inpatient care and can go home, or when they are transferred to another type of facility. Hospitals will discharge patients if they no longer need to be there for their care, but this does not necessarily mean that the patient is fully healed or recovered.

When a patient is discharged, they will go through a transition of care, meaning they will receive a different level of medical care outside of the hospital. For example, they may go to a skilled nursing facility, a rehab facility, or transition to home care.

Therefore, when LOA days are added to discharge days, it can affect hospital statistics by increasing the number of days that a patient is considered to be under the hospital's care, even if they are not physically present in the hospital. This can impact the hospital's readmission rates, average length of stay calculations, and bed occupancy rates. It is important for hospitals to accurately track and report LOA days and discharge days to ensure proper billing, resource allocation, and patient care.

LOA billing procedures

LOA, or Leave of Absence, is a term that applies to extended time away from work. In the context of hospitals, a patient on LOA is expected to be readmitted, but does not require hospital-level care during the interim period. For example, a patient awaiting surgery that cannot be scheduled immediately may be placed on LOA.

When billing for a patient on LOA, it is important to note that LOA is not considered two separate admissions. Therefore, the hospital should only submit one bill and only one Diagnosis-Related Group (DRG) payment will be made. To account for the non-covered days in the billed accommodation days/units, show non-covered days/units under revenue code 018x (LOA) with zero charges.

If a patient on LOA does not return within 60 days, including the day leave began, or is admitted to another institution during their leave, an adjustment bill (type of bill xx7) must be submitted. The day the patient left the hospital should be shown as the date of discharge.

In the case of a repeat admission, if a patient is discharged and later readmitted for a related condition, the hospital should adjust the original claim generated by the original stay. If the patient is readmitted for an unrelated condition, hospitals should place condition code (CC) B4 on the readmission claim (FLs 18–28) to indicate that the services are not related. The claim should also contain an admission date equal to the prior admissions discharge date.

Additionally, hospitals may use Letters of Agreement (LOA) as a tool to ensure prompt payment for medically necessary services. LOAs are typically used in specific situations, such as when a hospital needs to arrange payment for an individual patient with a health insurer with which the hospital does not have another type of agreement. LOAs define the scope of medical services provided and the compensation for the treatment. However, they often do not cover how disputes between the healthcare provider and insurer will be resolved. Therefore, it is important to include provisions for litigation in the LOA.

Patient readmission

The billing process for readmissions depends on whether the patient is returning for a related or unrelated condition. Hospitals use condition codes to indicate the nature of the readmission. In cases where the readmission is unrelated to the prior stay, hospitals must ensure that the claim reflects this, using specific condition codes and matching the admission date with the previous discharge date.

For readmissions related to the previous stay, hospitals adjust the original claim generated during the initial visit. This process involves submitting an adjustment bill when a patient on a Leave of Absence (LOA) does not return within 60 days or has been admitted to another institution during their LOA. It's important to note that LOA billing is treated as a single admission, generating only one bill and payment.

The transition from hospital to home is a critical period for patients, with the highest risk of readmission occurring right after discharge. Johns Hopkins Medicine employs various strategies to ensure a successful transition, including full medical, social, and financial assessments, medication management, and follow-up phone calls from nurses within two days of discharge. Some Johns Hopkins hospitals also offer bedside medication delivery and home visits by nurses, known as "transition guides," to ensure patients understand their medications and care instructions.

To monitor and improve patient care, organizations like Johns Hopkins Medicine analyze readmission rates and develop strategies to reduce them. The HCUP Nationwide Readmissions Database (NRD) is a valuable tool for tracking readmissions across hospitals within a state. This database includes discharges for patients with and without repeat visits and those who have died in the hospital, providing a comprehensive view of readmission patterns.

Patient leave against medical advice

Patients have the right to leave the hospital against medical advice (AMA). However, it is important to be aware of the risks of doing so. Hospitals decide whether to keep patients in care based on valid medical reasons, but patients may decide to leave because of high costs, poor care, or past bad experiences. Leaving AMA increases the risk of readmission, and patients may have more medical expenses if they have to be readmitted because of the early discharge.

When a patient leaves AMA, they are asked to sign discharge papers stating that they are leaving against their healthcare provider's advice. They are not legally obliged to sign these papers, but refusing to do so does not make the hospital legally liable if the patient gets ill due to the early discharge. The patient's "'informed refusal' of diagnostic testing, procedures, or treatments should be documented in detail. The patient should also be offered a one-time prescription for medication required for their immediate stabilization.

To protect themselves from liability, hospitals should ensure that patients are well-informed of the risks and benefits of leaving AMA. Patients should be given the opportunity to ask questions about their medical condition and be treated to the extent that they will allow. Follow-up care should be discussed and arranged, and the patient should be advised of symptoms to look out for that should bring them back to the hospital.

From a billing perspective, LOA days are not considered as separate admissions, and only one bill and Diagnosis Related Group (DRG) payment will be made. When a patient leaves AMA and returns to the same hospital on the same day for an unrelated condition, hospitals should place condition code (CC) B4 on the readmission claim.

Submission of medical records

The submission of medical records is a crucial aspect of healthcare data management and can significantly impact hospital statistics. Here are some instructions and guidelines to ensure accurate and timely submission:

Hospitals and healthcare facilities should establish clear and consistent processes for collecting and submitting medical records. This includes defining the types of records required, the frequency of submission, and the format in which the records should be provided. Standardizing the process across the organization ensures that data is comprehensive and comparable, enabling more accurate analysis and reporting.

Medical records should be submitted in a timely manner to ensure that hospital statistics remain up-to-date and reflective of the current situation. Prompt submission allows for real-time monitoring of key performance indicators and facilitates quicker identification of potential issues or areas for improvement. Hospitals should set specific deadlines for record submission and ensure that all departments and staff are aware of the importance of timely reporting.

To maintain data integrity and confidentiality, it is essential to implement secure methods for transmitting medical records. Hospitals should utilize secure electronic systems that comply with data privacy regulations, such as encrypted email platforms or specialized healthcare data exchange networks. These measures safeguard sensitive patient information and ensure that only authorized individuals have access to the records during the transmission process.

Complete and accurate documentation is vital for reliable hospital statistics. Incomplete or missing data can skew results and lead to incorrect interpretations. Hospitals should provide clear guidelines and training to ensure that all relevant information is captured in the medical records. This includes consistent coding practices, comprehensive progress notes, and accurate documentation of diagnoses, procedures, and outcomes. Regular audits and quality checks can help identify areas where improvements can be made in documentation practices.

It is important to establish a feedback loop and encourage open communication between the records submission team and the data analysis or statistics department. By fostering a collaborative environment, potential issues or discrepancies in the medical records can be identified and addressed promptly. Regular feedback also allows for process improvements and ensures that the submitted data is utilized effectively to drive decision-making and enhance patient care.

Finally, hospitals should invest in training and education for staff involved in the medical records submission process. This includes providing clear instructions, offering regular updates on any changes to submission requirements, and promoting a culture of data accuracy and timeliness. By empowering staff with the necessary skills and knowledge, hospitals can improve the overall quality and consistency of their medical record submission processes.

Frequently asked questions