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When it comes to talking with physicians about documentation or admissions criteria, it's often not what you say but how you say it that helps you get an answer.
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It's frustrating when you point out that a patient doesn't meet acute care criteria or that documentation in a chart is not complete and nothing happens, even if you take it to your physician advisor.
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Remember that the case manager-physician relationship is like a marriage and you have to keep working at it to make it a good one, says Steve Blau, MBA, MSW, LCSW-C, director of case management for Good Samaritan Hospital in Baltimore.
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Working for 10 years as emergency department nursing manager at St. Mary's Hospital in Tucson, AZ, Cassandra Pundt, RN, CEN, recalls she was constantly struck by the "tremendous need" for a patient advocate specifically dedicated to the ED.
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A clinical documentation review program at Jupiter (FL) Medical Center increased Medicare reimbursement by $278,000 the first year for the 156-bed community hospital.
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At New York Hospital Queens, a series of multidisciplinary, hospitalwide initiatives helped the hospital cut its length of stay by almost a day, despite an increase in the number of patients.
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Faced with almost 50% of its patient population receiving Medicare benefits, Berkshire Medical Center in Pittsfield, MA, took a proactive approach to comply with the revised Medicare regulation requiring hospitals to give patients the Important Notice from Medicare, informing them of their right to appeal their discharge.
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Self-pay emergency department patients who have no primary care provider are being referred to a nearby primary care and specialty center under a program in place at St. Mary's Hospital in Tucson, AZ, part of the Carondelet Health Network.
