{"title":"Project to Improve Throughput Cut Length of Stay, Helped Bottom Line.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 8","pages":"114-15"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36416534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Know the Payer Rules to Maximize Reimbursement.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 8","pages":"111-12"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36416536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CMS Issues Temporary Halt to Short Stay Reviews.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 8","pages":"112-13"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36416034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Case Management-Revenue Cycle Partnership Pays Off.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 8","pages":"113-14"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36416035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Case Managers are Link Between Clinical, Financial Sides.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As reimbursement tightens and payers issue ever-changing rules, it’s essential for hospital case managers to be involved in the revenue cycle by managing patients on admission, or even before they arrive, and following them through their hospital stay, ensuring that payer requirements are met so the hospital can get appropriate reimbursement.\u0000• Case management directors should meet regularly with representatives of the financial side of the hospital to discuss reimbursement issues and review the portion of insurance contracts that relate to the responsibilities of case managers.\u0000• Case managers should cover all access points of the hospital to prevent denials before they occur by ensuring patients meet inpatient criteria and are place in the right status.\u0000• Case managers should review every patient every day to make sure the days of hospitalization are authorized, that appeals are conducted concurrently, and that the discharge plan continues to meet the patient’s needs.\u0000• Hospitals need to provide continuous education to make sure that case managers understand the changing payer rules and regulations to know what each payer requires, and how and when to appeal.</p>","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 8","pages":"105-8"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36416525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Take a Proactive Approach to Managing Denials Before They Occur.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 8","pages":"108-9"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36416532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Review Every Patient, Every Day to Ensure Appropriate Reimbursement.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 8","pages":"110-11"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36416533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CASE MANAGEMENT INSIDER. Re-Engineering Your Case Management Department: It's Simple, It's Just Not Easy, Part 1.","authors":"Toni Cesta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This month, we have begun our discussion of the reasons why this is a very good time for hospitals to review and re-engineer their case management models and departments, including the Affordable Care Act and value-based purchasing, among others. Next time, we will discuss the elements you need to review when re-engineering your own case management department.</p>","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 7","pages":"95-8"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34745325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fresh Policies and Procedures, Transparency Fuel ED Turnaround.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 7","pages":"102-3"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34745330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Individual Malpractice Insurance Can Protect You in Case of Lawsuits.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In today's litigious society, case managers should have their own malpractice insurance to protect their assets, experts say. Attorneys cast a wide net and often include anyone who has interacted with the patient in malpractice lawsuits. When CMS' new discharge planning guidelines go into effect, case managers will be vulnerable to Lawsuits if discharges are unsuccessful. The hospital's legal counsel will not necessarily represent the case manager's best interests, which is why case managers need their own malpractice coverage.</p>","PeriodicalId":79972,"journal":{"name":"Hospital case management : the monthly update on hospital-based care planning and critical paths","volume":"24 7","pages":"100-1"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34745327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}