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In September 2011, the pre-registration, pre-authorization and insurance verification functions were centralized for four of the seven facilities that are part of Peoria, IL-based OSF HealthCare, reports Stacey Boland, director of patient access.
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Obtaining an authorization for a patient's series of chemotherapy visits is no longer enough, says Mollie Drake, corporate director of access at Scripps Health in San Diego.
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A hospital privacy and security compliance officer knows exactly what policies and programs within the organization are designed to protect patient information (PHI), but what should be expected of a business associate (BA)?
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When the Patient Protection and Affordable Care Act (PPACA) is implemented in 2014, "not only is our patient volume going to expand, but our role in patient access is also going to expand," predicts Michael F. Sciarabba, MPH, CHAM, director of patient access services at Advocate Illinois Masonic Medical Center in Chicago.
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Frail elderly patients are able to stay in their homes, thanks to home visits by an interdisciplinary team from Boston University's Geriatric Service at Boston Medical Center.
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As the Centers for Medicare and Medicaid Services (CMS) continue to increase its focus on discharge planning, case managers need to pay more attention than ever to ensuring that patients have the information they need to make informed choices about their discharge destination, says Jackie Birmingham, RN, MSN, MS, nurse educator/consultant in discharge planning and vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm.
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As part of the efforts to ensure that admissions are appropriate, Covenant Health System, with headquarters in Knoxville, TN, is conducting a pilot project to test the effectiveness of having utilization managers review patients admitted to the hospital, and work with the admitting physician to decide whether the patient should be admitted or receive observation services as an outpatient.
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In the last two issues of Case Management Insider, we reviewed the roles and functions most often associated with the work of case managers in the acute care setting.
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By identifying community resources for homeless and near-homeless patients, Montefiore Medical Center in the Bronx, NY, is cutting down preventable admissions.
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As part of its efforts to cut improper payments, the Centers for Medicare and Medicaid Services (CMS) has launched a three-year Recovery Audit program prepayment review demonstration project in 11 states.
