Hospital Case Management – August 1, 2016
August 1, 2016
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Case Managers are Link Between Clinical, Financial Sides
Today’s hospitals have to perform a balancing act between the clinical and financial sides of healthcare, focusing on providing top-quality care while following payers’ ever-changing rules and regulations and maintaining the bottom line.
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Take a Proactive Approach to Managing Denials Before They Occur
If hospitals are doing only denials management and not avoiding denials up front, they’re already behind, says Beverly Cunningham, RN, MS, consultant and partner at Oklahoma-based Case Management Concepts.
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Review Every Patient, Every Day to Ensure Appropriate Reimbursement
When case managers concentrate only on getting the patient status right up front and then review only selected patients and review them every few days, it’s likely to have a big effect on the financial health of the hospital, says Brian Pisarsky, RN, MHA, ACM, associate director of Emeryville, CA-based Berkeley Research Group.
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Know the Payer Rules to Maximize Reimbursement
In today’s world, it is imperative for the case management director to make sure the case management staff receives continuous training and education around payer rules and regulations, and the financial implications of what they do, says Mindy Owen, RN, CRRN, CCM, principal owner of Phoenix Healthcare Associates in Coral Springs, FL, and senior consultant for the Center for Case Management.
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CMS Issues Temporary Halt to Short Stay Reviews
Faced with concerns from providers and apparently inconsistent education being provided by the Beneficiary and Family Centered Care Quality Improvement Organizations, CMS temporarily suspended reviews of short hospital stays and ordered the QIOs to re-review every denial issued since they took over the reviews.
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Case Management-Revenue Cycle Partnership Pays Off
At Saint Francis Hospital in Hartford, CT, the revenue cycle team is a strong partner of case management, reports Beth A. Greig, RN, MSN, MBA, ACM, director of case management, healthcare value, and efficiency at the 617-bed hospital.
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Project to Improve Throughput Cut Length of Stay, Helped Bottom Line
A quality improvement project to shorten lengths of stay and improve throughput from the ED at Saint Francis Medical Center in Hartford, CT, decreased the length of stay by more than half a day from November 2015 through May 2016.