Hi, my name is Elizabeth Reffitt.
I’m the manager of case management services at St. Claire Regional Medical Center in Moorhead, Kentucky.
We have benefitted from their wonderful level of expertise and professionalism.
At our facility, we believe patients are the center of everything we do.
And we want to be paid the right amount for the care patients require in our hospital.
We don’t want more, we don’t want less.
We just want what’s right.
They have the expertise, the huge library, the information, the data that’s needed
to back up their decision.
Their, just excellent knowledge and skills has been invaluable to us to help prevent
denials for hospitalizations.
A patient may have been in the hospital just two or three days, and we can see very clearly
that they’re still requiring a lot of services that they can only receive as an inpatient
in the hospital, yet their payer is already telling us that from this day they’re going
to deny any further care.
So, they set up any peer-to-peer discussions in a very timely manner, and frequently are
very helpful with getting those denials overturned.
We’ve had a short stay review by our QIO.
I was able to, of course review this chart, pull that letter right out, and on the phone
call, I had highlighted the portions of the letter where the physician had stated what
the concerns were and why this patient required an inpatient stay, and use that along with
just a couple of other things and then that stay was approved.
So, it was very helpful.
The first thing that comes to mind is the education opportunities that they provide us.
They don’t just provide this to the case management staff.
They also have education for our physicians.
When we first started with the program, we had physicians and others come and do face-to-face
education.
They’re thoughtful, they’re considerate, they’re timely.
If we have any questions of concerns, we have a team that we work with.
When we send a referral to them their response is very timely, it’s very professional,
the letters we get, the calls that we get.
If there’s additional information needed they’re very helpful.