Understand the balance between business and healthcare

Understand the balance between business and healthcare

Clinical decisions should always guide patient care, but case managers also should keep payer requirements, coverage limits, and patient co-pays in mind as they coordinate care and develop a treatment plan. In this issue, we'll look at why case managers need to be informed about the how the hospital is paid and the implications their care plan might have for patients. We'll show you how one hospital's care management team collaborates with the contracting and business office. We'll give you tips for creative discharge planning when patients have coverage limits. We'll describe how one case management department's revenue integrity team includes nurses and follows the patient throughout the stay to ensure that the hospital will be paid appropriately. It's all in this issue of Hospital Case Management.