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The Long View

Federal Health Care Act

by Rob Long

Form 17Ai: End of Life/Authorized Life Termination/Difficult Next of Kin Reimbursement Procedures

Federal Guidelines for the Health Care Reform Act–authorized “End of Life Counseling” [ELC] procedures:

ELC sessions are now fully reimbursable as part of existing federal health-care programs and are encouraged for all patients of all ages and conditions.

Doctors will be reimbursed for conducting ELC sessions with ALL patients, and each facility is eligible to participate in the FAST-OUT-PREMIUM program, which reimburses at 175 percent each ELC that results in an Authorized Life Termination [ALT] within the same fiscal year.

Please note: You will be reimbursed ONLY if the following steps are completed and Forms XX7-1 and XX7-3 have been filed IN ADVANCE with your local billing center.

Prior to ELC session, please verify:

1. Patient is still breathing. (If patient is NOT breathing, or if this is a retroactive filing following a Non-Authorized Life Termination [NALT], please use form 17Bii: Post-Pull Authorization and Reimbursement Procedures.)

2. Patient registers life or lifelike symptoms in FOUR of the following six major areas: pulse, pupil dilation, light respiration, voice recognition, within earshot, in same general area (not to exceed 100 feet during counseling session).

3. Patient has not already filed Advanced Health Care Directive with sheaf of required paperwork from admission to hospital facility. PLEASE NOTE: Many facilities automatically enroll patients in the Federal Pull-the-Plug Plan (Reg. 12,965; page 4,520; Volume 47, Section 56R; ii) as a part of the sign-in process into a federal health-care facility. If this has ALREADY been accomplished, you WILL NOT be reimbursed for conducting the ELC. You MAY be eligible for PREMIUM FAST-TRAK reimbursement for Expedited Leave-Taking Procedures [ELTP] if you qualify. Please see NOTE A.

The ELC process as conducted must include the following points of discussion:

1. The intense pain the patient will undoubtedly suffer, right up until the end, unless “something else” is done.

2. The enormous cost and emotional toll on loved ones the patient is selfishly and pointlessly causing. [If loved ones refuse to participate or in some way remain obstructive, see NOTE B for additional reimbursement options.]

3. Meeting all your old friends, family, nanas, and pets on the Rainbow Bridge, as has been confirmed by science.

4. Large catheter shown to patient — “Do you want this stuck up your you-know-what, or can I pull the plug?”

5. Explanation that “it’s just a cold” isn’t a diagnosis a non–medically trained person is qualified to make. A cough and a runny nose and an “achy feeling” is a terminal condition, in many cases.

6. The patient should be informed that a lifetime of “sore throats” and “allergies” brings up quality-of-life issues that need to be addressed. Loved ones tortured by the sound of sniffling and cough-syrup slurping — is that something the patient can live with?

7. If patient is sedated and/or medicated during ELC session, reimbursement will be given for medications ONLY upon death of patient.

8. Obese patients may be counseled while watching doctor scoop ice cream and/or hold a bacon double cheeseburger aloft.

9. If a nurse is present, she may, if advisable, appear topless.

10. Patient should be reminded of the future toll of environmental disaster, global warming, terrorism, economic unrest, and societal breakdown. Does patient really want to live through all of that?

NOTE A: For PREMIUM FAST-TRAK reimbursement for ELTP, please verify the following conditions:

1. Patient signed papers upon admission to facility;

2. Nurse and/or complementary health-care professional was out of the room;

3. Relatives/next of kin were distracted by television;

4. Machine was turned off in an undetected fashion;

5. Organs were harvested.

NOTE B: For Difficult Next of Kin [DNK]:

1. Difficult Next of Kin may be encouraged to participate in the ELC with a DNK Voucher. ONLY a DNK Voucher will be reimbursed and ONLY if signed and counter-signed by billing director in your area. NO EXCEPTIONS. DNK Vouchers come in denominations of $1,000, $5,000, and $10,000. Issuance of DNK Vouchers in excess of $25,000 REQUIRES two (2) signatures from billing department, and an accompanying form.

2. DNKs can be admitted into the hospital facility for any reason, and for any surgeries, if necessary to conduct an effective ELC. All surgeries and procedures will be reimbursed and no accompanying paperwork will be required.

Thank you for your adherence to these guidelines. If you have any questions, please refer to our FAQ at http://healthcareguidelines.gov/reimbursement/endlife/costmanagement BEFORE you call our office.

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