Case Management

Case Management Q&A

Case Management Weekly, August 22, 2012

Q. Where does case management fit in the revenue cycle?  

A. For any institution, the revenue cycle is the lifeblood for maintaining profitability and ensuring that patients receive the services they seek in a cost-friendly manner. 

Case management’s role can be defined in terms that reflect its areas of expertise, including utilization review, discharge planning, regulatory compliance related to reimbursement, and the use the regulations to safeguard against unnecessary admission of patients. Case management also helps appeal denials and track and trend denials to facilitate process improvement. 

This week’s tip is adapted from Optimizing the Physician Advisor in Case Management: A Guide to Creating and Sustaining Measurable Program Results published by HCPro, Inc.

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