Tips for peer to peer

[peony]

---

Members do not see this ad.

I can't believe how stingy insurance companies can be about inpatient/residential days, even for young teens with serious suicide attempts. It puts families in a terrible position.

Does anyone have any tips for peer to peers? I am trying to stay factual with the data/behaviors I am seeing and state clearly that a patient would be unsafe and at high risk for another suicide attempt or readmission if we were limited to what we are being offered. I'm a fellow so kind of new to these. Thanks so much!

 

[Sushirolls]

Trial by fire, good luck.

When I was doing inpatient, we had one who said No to everything. Even threatened to report me for fraud, which I calmly deflected and encouraged to do so and was obligated to do so if believed fraud was being committed. Had to redirect this "peer" back to the patient case and clinical facts of why continued days were necessary. And a no was still given...

Peer-to-peer scat is definitely a log on the burnout pyre and burns a little hotter than the other wood logs.

 

[nexus73]

Everything you're worried about needs to be in the note (maybe it already is); it's a lot less effective to justify to peer to peer once you've been denied. In your note, paint a picture of how unstable, unsafe, etc the patient is and how they need continued treatment to get stable before they can discharge. If it's in your note it's easier for social workers to justify to insurance and not need to involve you. I put a discrete section in my note outlining Reasons for continued inpatient need: then explain.

 

[peony]

nexus73, how do you balance that with your need to show continued improvement so you can justify eventually discharging them? I guess you as accurately as possible say they are really impaired until the last day or two of admission?

 

[robellis]

nexus73, how do you balance that with your need to show continued improvement so you can justify eventually discharging them? I guess you as accurately as possible say they are really impaired until the last day or two of admission?

they are doing very badly up until they magically improve the day of discharge

 

[nexus73]

nexus73, how do you balance that with your need to show continued improvement so you can justify eventually discharging them? I guess you as accurately as possible say they are really impaired until the last day or two of admission?

It kind of flows naturally. For example, patient probably still suicidal even if passive for a day or two, then they need ongoing intensive encouragement from staff to engage in group, inpatient for close monitoring given recent significant medication changes, patient still feeling hopeless, not having SI so far today but feel they will decompensate if discharged and patient can’t contract for safety if discharged, limited natural supports and will likely stop meds/relapse/not go to follow up appointment so high risk for return of SI and rapid rehospitalization. All justifying (rightfully so) continued inpatient treatment for symptoms to stabilize for safe discharge. This is a haphazard list but many things you can describe to appropriately instill fear in the heart of the insurance reviewer.

Also, make sure you never estimate how many more days a patient will need. You don’t know, but insurance will latch onto that.

Also never document patient is just waiting for housing. The patient needs continued treatment for symptom stability before discharge is possible and ALSO case management continues to look for housing options for once patient is stable for discharge. Or just don’t mention “looking for housing” or “waiting for housing.” Insurance likes deny when they see this.

And seriously put a specific section at the bottom of your note justifying the continued stay because insurance is not going to read your whole amazing note and pull out the rationale to keep paying. You want to make it easy for a reviewer to agree with ongoing hospitalization so appropriate care is paid for and you won’t have to do peer to peers

 

[SmallBird]

I might have been shielded in jobs I’ve worked but I just don’t care about it. My strategy is to explain the case, reject the premise that the person over the phone can make a reasonable assessment, and let the chips fall and get on with my day.

 

[shahseh22]

I might have been shielded in jobs I’ve worked but I just don’t care about it. My strategy is to explain the case, reject the premise that the person over the phone can make a reasonable assessment, and let the chips fall and get on with my day.

you got lucky. if it gets denied, we have a lot of pressure to move the patients.