Hospital Case Management – June 1, 2021
June 1, 2021
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Understanding Medical Necessity Improves Utilization Review Process, Reduces Denials
The case management team should be trained thoroughly on utilization review and medical necessity to avoid payer denials. The goal is to ensure patients receive medically necessary, high-quality care. -
Target Low-Hanging Fruit in Preventing, Overturning Denials
The keys to preventing and overturning payer denials are to collect data to identify problem areas and to train staff in best practices. The case management team should understand the information each payer wants and how best to share those data.
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Patient-Centered Care Can Improve Transitions
Patient-centered care is a simple, evidence-based way to improve care transitions and patient outcomes. Hospital case managers can benefit from learning more shared decision-making tactics.
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Ethical Decision-Making for Case Managers
Every day, hospital case managers must make decisions — large and small — that affect the lives of their patients. Some of these are ethical decisions — what the case manager “ought” to do in a given situation. Since many decisions must be made quickly, hospital case managers should consider their ethics and plan ahead rather than reacting solely in the moment.
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Caring for Homeless Adults Through Case Management
As of 2020, more than half a million people were homeless in the United States. When a case manager cares for a patient who has no home or permanent place of residence, the plan can change quickly. While the general outline of the case management process might stay the same when serving a homeless individual, there are additional items to consider.
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Best Practices for Amputation Recovery
Case managers make a difference in the lives of their patients, even when patients are only in the hospital briefly. This is especially true when a patient is undergoing a life-changing or traumatic event, like limb amputation. Case managers can help guide the patient on what to expect during recovery and after. In some cases, they might be the only person who can help a vulnerable patient find help for a successful and less traumatic experience.
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A Tribute to a Case Management Pioneer: Karen Zander
In August 2020, we lost Karen Zander, one of the true pioneers in hospital case management. Karen’s name is synonymous with acute care case management. She spent a large part of her professional career advancing case management roles, models, and the measurement of case management outcomes.