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Don't get a false sense of security if the Recovery Audit Contractor (RAC) process seems easy at first, warns Brian Flood, CHC, CIG, Esq., advisory managing director for KPMG LLP's health care practice in Austin, TX.
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Case managers can play a vital role in the event of a pandemic by educating their patients on how to stay healthy and avoid exposure to disease.
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While hospital discharge planners make certain each patient's discharge and transition in care are handled with quality of care and safety in mind, it's the job of hospital operations chiefs to make certain the entire process runs smoothly and efficiently.
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The 2010 proposed rule for the Inpatient Prospective Payment System (IPPS) includes only minimal changes to the MS-DRG system from a coding and reporting standpoint but is likely to have a significant impact on hospital reimbursement, according to Deborah Hale, CCS, president of Administrative Consultant Services LLC, a health care consulting firm based in Shawnee, OK.
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Case management outcomes can be a powerful tool for identifying the need for operational changes or process improvements throughout your hospital, as well as demonstrating the value of case management.
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A pre-admission screening and educational program for patients having elective surgery has helped slash readmissions among patients treated at Geisinger Health System from nearly 20% a year ago to about 10% today.
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A few years ago, Christus Santa Rosa Hospital in San Antonio was $80 million in the red and was compliant with medical necessity and appropriateness of care criteria only 62% of the time, according to audits by the hospital's quality improvement organization (QIO).
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Several EDs across the country have initiated policies to encourage patients who don't face "true" emergencies to seek care elsewhere in the community and to find "medical homes," but none have been met with the outrage that descended upon the University of Chicago Medical Center recently.
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Hospitals and EDs that institute policies similar to the recent approach instituted at the University of Chicago Medical Center would do well to consider that they may be in violation of the Emergency Medical Treatment and Labor Act (EMTALA), warns Michael Frank, MD, JD, FACEP, FCLM, general counsel and director of risk management for Emergency Medicine Physicians (EMP) Management Group in Canton, OH.
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Most of the staff in the new senior emergency center at Holy Cross Hospital in Silver Spring, MD, came from the main ED, says David Cummings, RN, CEN, the hospital's emergency center director.
