Rules for Creating and Updating Account Numbers
1. Definition of Encounter – An encounter starts from the date/time that a patient enters a DCH facility until that time that they leave the facility. There must be only one account number per encounter.
A patient’s encounter may start as several different visit types - - ER, CLI, SDC - -but may be transitioned to a different visit type depending upon the needs of the patient. At no time should a new account number be created if the patient is still within an encounter.
Example #1: Patient is being seen in OP imaging for a CT scan with contrast. An account number with a visit type of CLI is created. The patient then develops a reaction to the contrast and is taken to the ER for further treatment of the reaction. The CLI account should be revised to now being an ED account.
If this same patient Is then admitted from the ED to an inpatient status, the same account number would then be updated to an IN visit type.
Example #2: A patient arrives for a scheduled outpatient surgery. A PRE-SDC account had been created for the patient. On the morning of the scheduled surgery, the patient arrives and the SDC account is moved to a fully registered SDC account. During the assessment, it is found that the patient has several lab values that necessitate cancelling the surgery and sending the patient to the ED for further treatment. The SDC account would then be revised to an ED visit type.
2. Northport to Regional Transfers – NMC and RMC are considered one facility. Transfers between the two facilities are to be handled in the same manner as transferring patients from one floor to another.
3. RCR – Recurring Accounts – Due to the nature of the account, RCR accounts must never be changed to IP, ER, SDC, INO, etc account types. Any transition from a RCR visit to a different visit type should be completed by creating a new account number for the IP/ER/SDC/INO, etc visit.
Example: Patient currently an inpatient at Noland LTACH with a RCR account set up for lab/x-ray services that DCH provides via contract. Patient is readmitted to DCH as an inpatient. The RCR account should be discharged and a new inpatient account created for the DCH inpatient stay.
4. Transfers to DCH IP Rehab Pavilion – DCH inpatients who are transferred to the IP Rehab Pavilion at NMC will have their DCH inpatient visit discharged and a new account created for the IP Rehab stay. This is required due to billing requirements.
a. Rehab patient to DCH Inpatient – Rehab account is discharged and a new account number is created for DCH Inpatient
5. Transfers to/from North Harbor Psychiatric facility – If the patient is in the ED going to North Harbor we would continue on the ED account number. If the patient is going to acute care from North Harbor we would create a new account for the acute stay.
6. Transfers to Noland LTACH at DCH Regional – Noland LTACH is not a DCH facility but is a separate entity leasing space from DCH. Transfers to and from Noland should be processed in the same manner as any other transfer from an outside nursing home or care setting. The one exception is that as DCH provides lab/x-ray services for Noland, a RCR account is set up for those ancillary services. That account is billed back directly to Noland.
a. If a Noland patient requires same day surgery, a regular SDC account must be created for use during that encounter. Once the surgery is completed and the patient is returned to Noland, the SDC account should be discharged.
7. SDC, IP or CLI Accounts for Procedures – If patient is scheduled in one of the procedural areas (NMC OR, RMC Main OR, Same Day Surgery, NMC and RMC Endoscopy, Cath Lab, Interventional Radiology), a new PRE-SDC, PRE-IN or PRE-CLI account is created for that procedure.
• If the patient is already an Inpatient, use that account unless the patient is in North Harbor or Rehab.
• For North Harbor and Rehab patients that are transferred, if patient is scheduled in one of the procedural areas, a new Pre-SDC account is created for that procedure.
8. Live birth vs stillbirth – If a newborn has an Apgar other than zero at the time of birth, the newborn should be given an account as a live birth even if the physician has documented the baby as being nonviable. If the baby does expire shortly after birth, the newborn account would then be discharged with expiration as discharge disposition. Stillbirth will only be utilized if no Apgar scores are present.
9. Scheduled Procedures that are Re-scheduled - a patient is scheduled for an appointment today and is registered only to find out they did not follow their prep or their labs (performed at a different facility) are abnormal. The technologists then determine that the patient can be accommodated on a different date of service. In order to maintain the integrity of the payments, data, and forms (i.e., copays, demographic data, and forms through VIM or scanning) and stay intact with the account/patient, it is appropriate to reschedule the patient using the same account number and have Patient Access undo the registration back to PRE or SCH.