CHPC Study Group

Senario on Trans Gender Registration to C & C

  • 1.  Senario on Trans Gender Registration to C & C

    Posted 10 days ago
    ​Scenario:
    I know this is a sensitive subject, but a real world subject.
    A Trans Gender, Male to female, comes in to your facility. At registration the patient insist on being registered as a female. The legal documentation, being his drivers license and birth certificate both say "Male."

    Up to this point this patient has not gone through the transition from Male to female. In fact, this patient has not even started the female hormone regiment that is required, for a long period of time, along with other pre-requisites, prior to any permanent surgeries are performed. At this point the patient identifies in his mind as a female, but has not had any treatments at all for the long and permanent transition.

    The hospital refuses to register the patient as a female because his identification states he is a male. The patient is actually being admitted for a diagnosis involving the prostate. So the treatment is geared toward a male issue.

    The patient is outraged that the hospital will not register him as a female. But according to your state regulation, the hospital has every right to go with the legally documented gender.

    Being so outraged, the patient decided to get a letter from his therapist, go and apply for his Passport. He successfully receives a Passport as a female. He is admitted again and has a legal Passport saying he is a female. Now remember, no treatment toward a transition has occurred. Only one visit to a physchiatrist has occurred.  The hospital is treating a male for a male condition.
    Thoughts on how this should have been handled differently or how it should be handled on the patient returning???

    ------------------------------
    Vicky Roe RN CPMA CHC Compliance Clinical Auditor
    Southeast Georgia Health System
    Brunswick, GASheldon Roe
    ------------------------------
    Certification Disclaimer


  • 2.  RE: Senario on Trans Gender Registration to C & C

    Posted 10 days ago
    Vicky...thanks so much for posting this as I think topics involving gender sensitivity are timely and appropriate given our current social climate.  However...I also recognize that for some people, these topics are simply just too hot to touch without sparking feelings that could detract from the question at hand.

    I'm going to send you a message offlist which has helped deal with this, particularly in areas where there these types of encounters may occur more frequently than in others.

    ------------------------------
    -------------Frank Ruelas--------------
    ► We don't fail unless we quit! ◄
    Next Study Session Topic(s) - The eGroups Shall Decide
    2020 CI Meet Up Sign Up: https://www.surveymonkey.com/r/26VLMS8

    ░ Pass the Exam Group for 2020 ░
    Melissa Singleton - Jan - CHPC
    Julie Clutter - Jan - CHPC
    ------------------------------

    Certification Disclaimer


  • 3.  RE: Senario on Trans Gender Registration to C & C

    Posted 10 days ago
    Vicky, we haven't had this so I don't have any comments on how we handled it, but some thoughts:

    1.  Does your system(s) have an alerts, such as allergies, where you can indicate "patient ID's as F prefers Jane"?
    2.  Do you have any patients with the exact same name (John James Doe) and same DOB?  If so, how do you distinguish them in your systems?  Can you do something similar?

    ------------------------------
    David Garrison
    Compliance/Privacy Officer
    SEARHC
    Juneau,AK
    ------------------------------

    Certification Disclaimer


  • 4.  RE: Senario on Trans Gender Registration to C & C

    Posted 10 days ago

    David,

     

    Thanks for responding. Our system has not faced this particular situation either. It was scenario faced in a large network in the state and  shared in a workgroup, (no PHI was shared, in fact I cannot be certain if this was an actual experience or just a scenario thrown out for discussion). However, we have several physicians in the surrounding area that are now specializing in trans gender care. So we do anticipate possible challenges like this or some other challenges.

     

    Recently I was struck by how AAPC dedicated a series of 3 articles on the subject in their monthly publication Healthcare Business Monthly. Although I cannot say the articles were particularly helpful to me, I at least felt like the conversation was ongoing, and healthcare across the country was identifying some logistical challenges, such as changes to the EMR Systems, ordering labs, etc.  

      

    We, as I am sure with  all healthcare providers, we want to give our staff all the tools and training available to make their jobs less stressful, with a clear process, and of course professional and seamless for the patient, so we are just thinking ahead.

     

    I ask the question and was hoping for some C & C, because this is an example of how healthcare is ever evolving, and if we can share experiences and/or processes our patients and our Workforce members will all benefit. This has always been a great group to do that in. This, along with so many things in healthcare, is certainly a sensitive subject, and I address it with respect and dignity.

     

    Getting back to your response, we are working with our EMR Software developers to explore our options. Since so much of the subsequent care the patient receives pulls  information that is generated in the initial registration, we have to be very cognizant of the clinical challenges. Our clinicians are doing the bedside care and we do not want any room for error in the care of our patients. We don't really have the answers yet, but we are actively working on what the options are.

     

    Thank you for your feedback, I really appreciate you being willing to engage in a conversation.

    Vicky

     

     

    Vicky Roe, RN CHC CPMA

    Clinical Auditor

    Southeast Georgia Health System, Inc.

    2415 Parkwood Drive, Brunswick, GA 31520

    Office:  (912) 466-3264   Fax:  (912) 466-7044    Emailvroe@sghs.org

     

    This e-mail and any attachments may contain privileged and confidential information and are for the sole use of the intended recipient. Any unauthorized review, use, disclosure, or distribution is prohibited. If you have received this in error, please contact the sender by telephone or e-mail immediately and destroy all copies of the original immediately.   "noscramble" means the email is being sent unencrypted

     

     




    Certification Disclaimer


  • 5.  RE: Senario on Trans Gender Registration to C & C

    Posted 9 days ago
    I would be very interested in thoughts on this as well.  We have faced similar questions, but had no issues from the patient when we explained we had to go by the legal identification.

    ------------------------------
    Ashlee Walden
    Compliance Director
    Nashville,TN
    ------------------------------

    Certification Disclaimer


  • 6.  RE: Senario on Trans Gender Registration to C & C

    Posted 9 days ago
      |   view attached
    Vicky,
    This is something that I have worked with and have some great staff within my company that have addressed these matters.  I work for a private not-for-profit physician healthcare company.  Our main business is the care and treatment of HIV/AIDS/STDs and HepC.  We also provide Trans care, PrEP, PEP, HIV education, counseling and testing, dental care, mental health, and pharmaceutical services.  To that end we have many clients that have gone through or are in the process of gender reassignment.  We have worked with our EMR vendor, eClinicalWorks, to design specific fields that address client pronouns, but also what they identify as (see attached).  We would register the patient by what they were at birth, then by what they identify as at the time of the service.  What the patient might need to realize is that it also matters how the insurance company has him/her designated.  If your company is filing for a claim, it must be done as the insurance company recognizes the patient.  By using what they identify as, our staff are seen as more culturally competent and this makes the client/patient more comfortable.

    Hope this helps.

    ------------------------------
    Patrick Forand, MPH, CHPC
    Director of Risk Management
    CAN Community Health
    Sarasota, Florida
    ------------------------------

    Attachment(s)

    pdf
    Transgender Setup ECW.pdf   265K 1 version
    Certification Disclaimer


  • 7.  RE: Senario on Trans Gender Registration to C & C

    Posted 9 days ago

    Patrick,

     

    Thank you for your feedback. Your attachment was great. I will show this to our IT Department/EMR Developers and to our workgroup. I can see how this would aid our staff. There are a lot of variables and choices of preferred pronouns. Having a comprehensive list in front of you, as you are registering the patient, should relieve some anxiety with our Workforce. I know we have identified some available fields, and we have discussed something similar, but not nearly as comprehensive. Your attachment is one I have not seen as of yet. Thank you so for sharing.

     

    Vicky

     

     

    Vicky Roe, RN CHC CPM

    Clinical Auditor

    Southeast Georgia Health System, Inc.

    2415 Parkwood Drive, Brunswick, GA 31520

    Office:  (912) 466-3264   Fax:  (912) 466-7044    Emailvroe@sghs.org

     

    This e-mail and any attachments may contain privileged and confidential information and are for the sole use of the intended recipient. Any unauthorized review, use, disclosure, or distribution is prohibited. If you have received this in error, please contact the sender by telephone or e-mail immediately and destroy all copies of the original immediately.   "noscramble" means the email is being sent unencrypted

     

     




    Certification Disclaimer


  • 8.  RE: Senario on Trans Gender Registration to C & C

    Posted 9 days ago
    Vicki,
    You are welcome.  If you have any other questions, please don't hesitate to reach out to me.

    Thank you

    ------------------------------
    Patrick Forand, MPH, CHPC
    Director of Risk Management
    CAN Community Health
    Sarasota, Florida
    ------------------------------

    Certification Disclaimer


  • 9.  RE: Senario on Trans Gender Registration to C & C

    Posted 9 days ago
    This is a great topic! I don't work on the provider end, I actually work on the insurance side. However I have seen many providers moving to a system that captures the individuals gender at birth and then also captures how the person identifies, including any new name they go by. This not only allows you to log their legal name (as stated on any DL, Passport, etc.) but also allows you to be more sensitive to who they actually identify as and that all providers are using the correct pronouns when talking to him or her or them regardless of what's on their DL.

    The first thing that caught my attention when reading this scenario was "how does the front end staff know this individual has had NO hormone regiment, NO treatments, NO transition services at all, etc." That seems like very personal information that isn't commonly shared. In my opinion all of that information is moot, it truly comes down to what is on his legal documents.

    From an insurance perspective, this is an issue we've had to handle as well. We receive millions of claims and a large percentage of them auto-adjudicate (meaning they get processed through our system automatically and no one actually reviews them). Certain claims are programmed to stop with 'edits'. The edits are there to catch errors in claim submissions. Gender is one of those edits. If we receive a claim for a prostate exam but our system has that person as a female, that claim will stop for review. Same with if a claim came through for paps smear on a male. In those situations we have examiners review the claim and review any notes we have on file. IF we have notes that identify that person as being transgender, the claims is processed as usual. If we don't have notes then we investigate further to see why there was a mis-match. Speaking more broadly, I know many insurance companies are starting to remove gender edits because of this very situation and implementing other processes to help identify claim errors.

    ------------------------------
    Jill Volanti
    Director of Compliance
    Mesa,AZ
    ------------------------------

    Certification Disclaimer


  • 10.  RE: Senario on Trans Gender Registration to C & C

    Posted 9 days ago
    Jill,

    Thank you for your response. The only challenge we have faced thus far is getting an electronic lab order to go across to the lab without giving us an error, due to the sex entered at registration not matching the edits for that particular lab, different labs but similar edit issues as you described. Since then some software edits have corrected that problem. Although it was high drama in the middle of the night when the patient was sick and the physician wanted the labs ASAP.  This certainly made us more aware we had to begin to work on challenges that we would certainly face having physicians in our areas who are now specializing in the care of Trans gender patients and will be utilizing our facilities. Anyway, we are tracking the lab work all the way to the payment cycle to see if we have any payment challenges.

    The scenario I listed was not a real one. It was used in a workgroup at another healthcare system, along with other scenarios, to prompt discussions I think. No real patient and no PHI. But you are right, at registration, now one would know the patients history of treatment.

    You bring out some good information though. Is there a benefit from your perspective, in encouraging our patients to follow up with their insurance companies to make sure it is noted in their file that they are going though gender reassignment? I could see how this could get very frustrating from an insurance payment perspective...not sure all insurances are on top of this as your company. Our concern on a payment perspective has been this would be used to hold up claims from payment. Your thoughts?

    Thank you so much for your input.
    Vicky

    ------------------------------
    Vicky Roe RN CPMA CHC Compliance Clinical Auditor
    Southeast Georgia Health System
    Brunswick, GASheldon Roe
    ------------------------------

    Certification Disclaimer


  • 11.  RE: Senario on Trans Gender Registration to C & C

    Posted 9 days ago
    Hi Vicky - We try to stay on top of it but it can be a challenge! Section 1557, the Non-Discrimination regulations under the Affordable Care Act, made us take a deeper dive into our system(s) in order to avoid unnecessary "hang-ups" since there are regulatory requirements that need to be met for claim turn-around times.

    I definitely think there is a benefit in having patients follow-up with their insurance companies. As consumers of medical care, and the market shifting to more consumer driven health plans, I think it's important for all individuals to be more hands-on and involved with not only the care from their providers, but their insurance companies as well. Working as a team versus working against. Having that type of information upfront avoids a lot of back-end work such as requesting medical records or inadvertently denying valid claims (causing more work for ALL parties).

    This is a topic I'm very passionate about and I'm aware we are totally off the topic of HIPAA, but if you have any additional questions, feel free to reach out to me.

    ------------------------------
    Jill Volanti
    Director of Compliance
    Mesa,AZ
    ------------------------------

    Certification Disclaimer


  • 12.  RE: Senario on Trans Gender Registration to C & C

    Posted 8 days ago
    Hi Vicky,  I'm sure Frank will give you great advice.  I haven't got any experience in this subject.  My take on it, is billing is going to be rejected if you have a male diagnosis and label them as female.  Whatever insurance this person has, someone will have to investigate how it can be handled so the hospital will be paid.  Don't necessarily think it is in the compliance area but interesting.

    ------------------------------
    Barbara Naimark
    Compliance Manager
    Hospice of the Chesapeake
    Severna Park,MD
    ------------------------------

    Certification Disclaimer