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Risk & Quality Management

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  • Uninsured patients require creative discharge plans

    With the increase in uninsured and underinsured patients, hospitals face the challenge of finding post-acute care for unfunded or underfunded patients, or keeping them in a bed when they no longer need the acute level of care.
  • Community wide effort assists uninsured, homeless

    In its efforts to ensure that the uninsured and homeless receive the healthcare services they need, Carondelet Health Network in Tucson, AZ, has developed a list of community resources and partnered with community agencies to provide care for patients underserved patients.
  • Think like a payer when patients are uninsured

    In order to provide consistent post-acute care for uninsured or under insured patients, hospitals need to think like payers and develop a payment assistance policy so that at admission or registration, a financial counselor can do a quick assessment and determine who qualifies and who doesn't, according to Matt Boettcher, LSW, MSW, vice president for continuum of care for Scott and White Healthcare, with headquarters in Temple, TX, and consultant for the Center for Case Management, a patient care management consulting firm based in Wellesley, MA.
  • Dedicated CM coordinates discharges for patients

    At Montefiore Medical Center in the Bronx, NY, a complex care case manager coordinates appropriate post-discharge options for uninsured and under-insured patients who are likely to need complex care after discharge.
  • Community joins forces to care for uninsured

    In Lee County Florida, providing healthcare for the uninsured and under insured is a community-wide effort, according to Chris Nesheim, RN, MS, CMAC, system director, case management, Lee Memorial Health system with headquarters in Ft. Myers, FL.
  • Proactive approach identifies benefits

    Faced with an increasing number of patients who have no insurance and can't afford to pay for their own care, the University of Iowa Hospitals and Clinics in Iowa City, has developed a multi-pronged approach to identify indigent patients early in their stay and help them get access to community providers who can provide ongoing care.
  • Process for orders is patient friendly

    Provider's offices are no longer the "middleman" between schedulers and patients at Spectrum Health in Grand Rapids, MI, due to a newly implemented process.
  • HIPAA Regulatory Alert: Study: Breaches of data up 32%

    The second annual benchmark study by Ponemon Institute in Traverse City, MI, sponsored by ID Experts, finds that the frequency of data breaches in healthcare organizations surveyed has increased by 32%.
  • Payer mix soon will be more complex

    Within one year, the patient access department at Advocate Illinois Masonic Medical Center, a 408-bed hospital in Chicago, reduced denials due to no benefit coverage and no authorization by 30%.
  • Take steps now to prevent revenue loss

    Regardless of whether patients are covered by a commercial carrier, an employer group, or a combination of both, new processes are needed for patient access areas, says Gail Draper, director of clinic support services at University of Utah Hospitals & Clinics in Salt Lake City.