CMW Sneak Peek: Transforming the elective precertification process
Case Management Weekly, November 26, 2008
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The corporate care management staff at the University of Pittsburgh Medical Center (UPMC) knew its system of using nonclinical staff members to review plans for elective surgical admissions begged for restructuring. Communication was poor, length of stay (LOS) was up, and denials were difficult and time-consuming to appeal.
That’s why in 2006, the organization moved the nurse liaisons under case management supervision. The shift from patient access to care management allowed the nurses to review accounts with an eye toward:
- Improving documentation: The nurse liaisons were charged with reviewing the pre-arrival plans for patients and making suggestions prior to patient arrival.
- Managing length of stay: By being involved from the get-go, the nurse liaisons were better able to verify the validity of a physician’s authorization for a patient’s hospital stay—and argue it before they were faced with a denial.
- Preventing denials: By ensuring the correct authorization has been made for each case, care management has been able to plan ahead for the appropriate level of care.
Check out the November 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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