Articles Tagged With:
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Sparse Neurology Exam Complicates ED Defense of Missed Stroke
Sparse or inaccurate charting allows plaintiff attorneys to allege inadequate neurological examination in missed stroke cases against EPs. However, documentation that includes a thorough description of all the aspects of the exam, an explanation of why the EP didn’t think stroke was likely, and an indication that the EP consulted a neurologist can help the defense.
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Late Electronic Medical Record Entries Create Indefensible ED Malpractice Claims
Malpractice cases may become indefensible if the forensic IT expert can prove the ED chart was altered in some way. Data regarding physical examination or history can appear self-serving. The veracity of altered information will be questioned. Even if the EP’s motive was valid, it may appear otherwise.
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EPs Face Legal Exposure as ‘Captain of the Ship,’ Even for Triage Mistakes
An EP could be hundreds of feet away when a patient with a life-threatening condition is mistriaged. That doesn’t necessarily stop an affected patient from suing that EP for the resulting adverse outcome.
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Hospital Standardizes Debriefing After Critical Events
The maternal and fetal medicine team at Sharp Grossmont Women’s Health Center, affiliated with Sharp Grossmont Hospital in La Mesa, CA, improved quality of care recently by implementing a standardized debriefing process for critical events.
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Patients Threatened by Gaps in Care When They Change Settings
Patient safety and quality of care are threatened when patients move from one setting to another, but there are strategies that can address those gaps in care.
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Revenue Cycle Team Optimizes Reimbursement
If a hospital doesn’t have a revenue cycle management committee, case managers can approach leadership and suggest that they propose that the hospital administration create a committee to review all contracts and denials.
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Large Caseloads Make Denial Prevention Difficult
Hospitals that pile task after task on case managers and assign them large caseloads are unlikely to effectively manage denials.
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Be Knowledgeable About Hospital’s Payer Contracts
To prevent denials, case managers must know the requirements of each individual payer. But at some hospitals, the finance and/or managed care departments don’t provide case management with the utilization review section of the contract where the rules are outlined.
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How to Avoid Four Types of Denials
Case managers must take a proactive approach to reducing the denial rate — and the best way to do it is to prevent the denial.
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Types of Case Manager Reviews
This chart shows the types of payer reviews case managers typically perform.