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CMW Sneak Peek: Case managers can make a difference in improved coding

Case Management Weekly, June 25, 2008

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Although many think a case manager’s job includes utilization, resource management, and length-of-stay (LOS) management, case managers can be involved in much more. One area in which case managers are playing a greater role is in ensuring physician documentation. By teaming with the health information management and coding departments, case managers can realize greater involvement in monitoring and ensuring physician documentation through physician education and coaching. This will help ensure that the hospital gets credit for the services rendered, appropriate lengths of stay for patients, and the correct reimbursement, says Debbie Russell, BSN, MBA, CMAC, executive director of patient resource management at Regency Hospital Company in Alpharetta, GA.

“Case managers can also assist coders in interpreting physician assessments, treatments, and interventions, and with assigning the correct diagnosis codes and [Medicare Severity DRGs (MS-DRG)],” says Russell. “If you don’t have the documentation to support care and services you provide, you will risk increasing denials or miss the mark on length-of-stay management and appropriate reimbursement.”

Check out the June 2008 issue of Case Management Monthly to get the full story, and discover all the benefits of being a Case Management Monthly subscriber.

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