I. Purpose
Effective immediately, Saint Rectory Memorial Hospital System will implement a newly developed series of Medicare-aligned Patient Discharge Protocols designed to ensure full compliance with federal reimbursement requirements related to Gastrointestinal Evacuation Verification (GEV) prior to patient discharge.
As you are all aware, the Centers for Medicare & Medicaid Services (CMS) has increasingly tied hospital reimbursement rates to measurable patient outcomes, and our internal Revenue Cycle team has confirmed that there is a direct correlation between documented fecal output and maximum allowable billing under DRG-based reimbursement models.
In plain terms: if our patients don't poop, we don't get paid.
This memorandum outlines the mandatory procedures, documentation requirements, and staff responsibilities necessary to ensure that every discharged patient meets the new Fecal & Flatulence Discharge Criteria (FFDC) and that every discharge is coded, billed, and reimbursed at the highest possible rate.
II. Background — Why This Matters Financially
Our Revenue Cycle Management department has conducted a six-month internal audit and identified the following:
| Metric | Finding | Financial Impact |
|---|---|---|
| Patients discharged without documented fecal output | 34% of all discharges | Estimated $1.7M in lost or downcoded reimbursement claims |
| Patients discharged without a verified anal release of wind (fart) | 61% of all discharges | Estimated $2.3M in missed quality bonus payments |
| Discharges where nurses documented "patient states they passed gas" with no clinical verification | 44% of all flatulence claims | Flagged by CMS auditors for insufficient evidence |
| Cases where the Fecal Output Log was left blank | 28% of charts | Billing delays averaging 14–22 days per claim |
This represents a total estimated annual revenue loss of $4.1 million — revenue we are entitled to under the new Medicare quality reporting framework, provided we document everything properly.
We did the work. The patient pooped. The patient farted. We just didn't write it down. We are literally flushing money down the toilet — which, ironically, is exactly where we need our patients to be going.
Questions regarding this policy may be directed to:
Phone: Ext. 2800 (ask for "the poop guy" — they'll know who you mean)