Meditech 5.6 outpatient to inpatient

[lgabbert]

Our hospital has Meditech 5.6. We want to know what others are doing when a patient comes in as outpatient for preop type and screen, then is admitted after surgery and then receives blood transfusion. Since these are two separate accounts, how does billing handle this, and also, if we want to set up TAR, how does nursing find the correct account when the blood bank is on the out patient account?

Currently, someone transfers billing from the outpatient account to the surgery account when the patient is a presurg. However, when the patient is admitted to the floor, i.e. orthopedic surgery, we have issues. All advice is welcome!

[Lcsmrz]

We are on Meditech CSv5.64 and have the same problem with our PAT patients. A little manual intervention is necessary on our part to get the system to work.

We perform a T&S on the PAT sample to affirm eligibility and enter the results against the original order, but we cancel the RBC order. Our PAT nurses have a series of questions on the EMR checklist about pregnancies and prior transfusions. Once eligibility is confirmed, the patient is written on our schedule board for the surgery date. At our facility, the patient must wear the BBK wristband from sample collection until removal by hospital personnel at discharge.

After the patient arrives for surgery, the BBK re-orders another T&S and the RBC order under the new encounter, retreives the sample, redoes the patient's ABO/Rh (but not the screen), and performs the IS XMs. The charge for the second T&S is cancelled, and there is no delay in product availability.

This gives us 3 days after crossmatch to issue the products and allows TAR to work as designed. It has a minimal BBK intervention, is easy and safe, and makes everyone happy. Most important, it gives us a heads-up on positive Ab screens.

Fortunately, we do this procedure only a few times a year ...

[PammyDQ]

Our patients complete and sign a questionnaire (Blood Bank Notification Form) when they come in for PreAdmission Testing within 21 days of surgery, and that is sent to our BB with the specimen. We enter the TS on the PAT account.

If they have answered "yes" to having been pregnant or transfused within the last 3 months, we will request that a new specimen without an order be collected when they come in day of surgery and we will repeat the IAT(we record that on the patient's result card (which did not "go away" when we got a BB computer module). Also if the patient had no ABO history and they are non-O, we will request an ABO confirmation specimen be drawn. We get a copy of the surgery schedule the day before and we match it up to all the PAT questionnaires to make sure everyone is covered and let pre-op know what they need to draw the next day when the patient comes in.

Any Products (for crossmatches) are ordered day of surgery, which is considered "day 1" of the specimen, regardless of the date it was collected (within 21 days). Any post-op crossmatches that are ordered, we change the date/time of collection to the date/time of surgery, therefore when you print your Expired Crossmatch Report the units that aren't transfused will come up.

[Susan.Sullivan]

Meditech has a function of "Move to Another Acct" that will allow you to move the PAT blood work onto the SDC account. The specimen information, commentsm test results and all audit information remove the same; it just merges the two requisitions. We use this often to resolve billing rejections. this is available in Meditech SC 5.54 and it will be available in Meditech CS 6.0.

[DANDERS]

Depending on the patient's insurance and it's rules, registration gives a Pre-Clinical V# for pre-op testing and a Pre-Inpatient V# or a Pre-SameDaySurgery V# for the surgery. If the Pre-op visit is close enough to the surgery date they're given one V#. We use the MR# in blood bank so the different V#s don't cause us any problem. We also use the Move to Another Acct routine.

[sgoertzen]

Susan - where is that routine located? We are on C/S 5.62 and I am not finding it.

Thanks! Sheri

[goodchild]

Susan - where is that routine located? We are on C/S 5.62 and I am not finding it.

Thanks! Sheri

In my experience a lot of people's meditech's are arranged differently but at my facility you can find that under the Requisition Desktop - Move to Account options.

[macarton]

We are on 5.64 and pre admit with the inpatient number. We have done this for years and have not had a problem with billing & reimbursement. We have a survey the patient fills out and if no pregnancy or transfusion last 3 months will use the sample 7 days.

[LaraT23]

We just went live with CS 6.0 ( SO FUN) and we still do the same things. We result the TS on the prein registration, and hold the unit set up to the night before surgery. Billing then converts the visit to the inpatient one if there are not medicare/insurance issues. If there are, we use the move to another account routine before we set up the crossmatches. This is of course only on our 10 clot patient who answers the pregnancy and 90 transfusion questions as No. If they are yes, we draw a new specimen the morning of their surgery, and that goes on the inpatient visit number.