Case Management

Case Management Articles by Topic: Regulatory Compliance

Mentor moment: Discharge planning in a changing healthcare environment

  • Case Management Weekly, Issue 39, September 26, 2012

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Sneak peek: Physician advisor job description

  • Case Management Weekly, Issue 25, June 20, 2012

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Mentor moment: Senators ask for a new ACO proposed rule

  • Case Management Weekly, Issue 22, June 1, 2011

    Seven U.S. senators believe the Accountable Care Organization (ACO) proposed rule will not only...

Former non-profit owner to serve 12 years for fraud scheme

  • Compliance Monitor, Issue 18, May 4, 2011

    Shirlene Reese Boone of Murfreesboro, NC, will serve 12 years in prison followed by three...

Mentor moment: Improve relationships with postacute facilities

  • Case Management Weekly, Issue 15, April 13, 2011

    Hospitals can begin laying the groundwork for ACOs by developing relationships with postacute...

Sneak peek: CMS answers questions about the second IM

  • Case Management Weekly, Issue 15, April 13, 2011

    The ACMA has received a document from CMS that answers questions that ACMA members posed to the...

Mentor moment: ACMA meets with CMS to discuss face-to-face requirement concerns

  • Case Management Weekly, Issue 13, March 30, 2011

    The ACMA public policy committee presented its concerns about the new face-to-face requirement to...

News: Acute care hospital IPPS information available in print format

  • Case Management Weekly, Issue 4, January 26, 2011

    “Acute Care Hospital Inpatient Prospective Payment System” is now available in print...

Sneak peek: Patient choice is about quality, not quantity

  • Case Management Weekly, Issue 49, December 8, 2010

    Jackie Birmingham has found no evidence that Medicare requires a specific number of discharge...

Case Management Monthly December 2010

  • Case Management Monthly, Issue 12, December 1, 2010

    Inside: Strengthen postacute relationships to prepare for healthcare reform Handling IV...

Properly using condition code 44 and capturing your costs

  • Case Management Monthly, Issue 12, December 1, 2010

    Condition code 44 has been problematic for hospitals since its inception in 2004 due to CMS&rsquo...

Mentor moment: RAC talk with Kimberly Anderwood Hoy

  • Case Management Weekly, Issue 46, November 17, 2010

    The Revenue Cycle Institute asked Kimberly Anderwood Hoy, Esq., about Recovery Audit...

Tip: Offering patients one postacute choice

  • Case Management Weekly, Issue 43, October 27, 2010

    In some situations, only one provider may be capable of meeting a patient’s clinical...

Sneak peek: Top 10 hospital case manager best practices

  • Case Management Weekly, Issue 43, October 27, 2010

    Over the years, case management has evolved as it has continually responded to ongoing changes in...

Divide and conquer: Taking the UR out of case management

  • Case Management Monthly, Issue 10, October 1, 2010

    To begin to think about separating the UR function from the case management role, you must question...

News: CMS publishes RAC improper payment vulnerabilities

  • Case Management Weekly, Issue 39, September 29, 2010

    CMS released two additional special edition MLN Matters articles to educate providers regarding...

Q&A: What is the role of the physician advisor in discharge planning?

  • Case Management Weekly, Issue 39, September 29, 2010

    Physician advisor (PA) involvement in discharge planning varies among organizations. The answer to...

Q&A: Specific post-acute orders

  • Case Management Weekly, Issue 34, August 25, 2010

    Q. Should physicians write an order for a specific post-acute care provider, such as an HHA or a...

Mentor moment: Case management involvement in implementing healthcare reform

  • Case Management Weekly, Issue 28, July 14, 2010

    I was privileged to be a part of the American Case Management Association’s (ACMA) Advocacy...

Tips for crafting a successful appeal letter

  • Case Management Monthly, Issue 7, July 1, 2010

    The appeal process is much more complex than conducting a clinical review for an insurance company...

Tip: When to start and stop the observation clock

  • Case Management Weekly, Issue 26, June 30, 2010

    Managing patients in need of mental health services requires the ability to properly navigate the...

Patients deserve a choice in the discharge plan

  • Case Management Monthly, Issue 6, June 1, 2010

    Medicare rules require hospitals give patients a choice between postacute facilities. Learn how to...

Is the second Important Message from Medicare important?

  • Case Management Monthly, Issue 6, June 1, 2010

    The American Case Management Association (ACMA) Public Policy Committee is in communication with...

The results are in: 2010 case management salary survey

  • Case Management Monthly, Issue 5, May 1, 2010

    The following are the highlights from the 2010 Case Management Monthly salary survey. We received...

RAC medical necessity audits are coming - are you ready to appeal?

  • Case Management Monthly, Issue 4, April 1, 2010

    Experts expect the RACs to begin auditing medical necessity this summer. Case managers may be asked...

Interpreters help overcome linguistic and cultural barriers

  • Case Management Monthly, Issue 4, April 1, 2010

    Considering communication is at the heart of what all case managers do, case management leaders...

Tip: Advise patients about their post-acute facility choices

  • Case Management Weekly, Issue 11, March 17, 2010

    The only time a discharge planner should discourage a post-acute referral is when the selected...

Sneak peek: How can discharge planning prevent readmissions?

  • Case Management Weekly, Issue 9, March 3, 2010

    The handoff of patients from the hospital to another care provider is a critical transition...

ACE demonstration improves care coordination and lowers costs

  • Case Management Monthly, Issue 3, March 1, 2010

    Instead of paying for hospital and physician ­services ­separately, the ACE demonstration...

Interstate transfers create financial, logistical challenges

  • Case Management Monthly, Issue 3, March 1, 2010

    When executing an interstate transfer, case managers must account for different Medicaid programs...

Tip: Discharge planners ’worksheet’

  • Case Management Weekly, Issue 8, February 24, 2010

    Patient-specific information must be documented in the patient’s medical record to ensure...

News: CMS confirms HCPro's condition code 44 guidance

  • Case Management Weekly, Issue 6, February 10, 2010

    CMS recently answered new condition code 44 questions on its FAQ Web site. The CMS answers confirm...

Tool: Dealing with government auditors chart

  • Case Management Weekly, Issue 6, February 10, 2010

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers. The intent...

Your condition code 44 questions answered

  • Case Management Monthly, Issue 2, February 1, 2010

    Experts answer questions about proper use of condition code 44.

Sneak peek: Milliman or InterQual: Which product is right for your facility?

  • Case Management Weekly, Issue 4, January 27, 2010

    It’s very likely that at one time or another, every person is asked one of the following...

CMW news: Survey says recession causing medication errors

  • Case Management Weekly, Issue 3, January 20, 2010

    Hospital workers participating in an Institute for Safe Medication Practices (ISMP) survey say the...

CMW Tip: What to do when a patient refuses a bed

  • Case Management Weekly, Issue 3, January 20, 2010

    What should I do in the following situation? A patient no longer requires hospital level of care...

CMW sneak peek: Your condition code 44 questions answered

  • Case Management Weekly, Issue 3, January 20, 2010

    In a recent HCPro audio conference titled “Condition Code 44 and the Utilization Review...

CMW mentor moment: ACE demonstration project could change how CMS pays hospitals and physicians

  • Case Management Weekly, Issue 2, January 13, 2010

    Essentially ACE changes how Medicare pays for healthcare services. Instead of paying the hospital...

CMW Mentor moment: RAC begins complex DRG validation audits

  • Case Management Weekly, Issue 49, December 9, 2009

    Connolly Healthcare has announced the first issues approved for complex RAC review, and providers...

CMW mentor moment: Promoting efficient use of resources and appropriate hospitalization length of stay to physicians, a different approach

  • Case Management Weekly, Issue 30, November 18, 2009

    Change is on the horizon. CMS currently is considering provisions that will promote the efficient...

CMW sneak peek: Pilot program identifies the cause of frequent ED visits; patients overcome barriers

  • Case Management Weekly, Issue 30, November 18, 2009

    University Health Care Center (UHCC) in Syracuse, NY modeled its program for handling frequent ED...

CMW tip of the week: Informing immigration officers about an undocumented alien

  • Case Management Weekly, Issue 42, October 21, 2009

    Are hospitals required to inform immigration officers when an undocumented alien seeks care?

Free software can help you prepare for RAC audits

  • Case Management Monthly, Issue 9, September 1, 2009

    Do you ever wonder how the postacute transfer rule will affect the reimbursement for a particular...

CMW Tip of the Week: Consider other level-of-care options

  • Case Management Weekly, Issue 29, July 22, 2009

    This week’s tip comes from Deborah Hale, CCS, author of Observation Status: A Guide to...

CMW Tip of the Week: MedicareFind.com launches

  • Case Management Weekly, Issue 26, July 1, 2009

    HCPro, Inc. is pleased to announce the launch of MedicareFind.com, a new regulatory database...

CMW News: California fines 13 hospitals for errors

  • Case Management Weekly, Issue 21, May 27, 2009

    The California Department of Public Health has collected approximately $1.2 million in fines from...

CMW News: Unnecessary hospital admissions cost Medicare $20 billion

  • Case Management Weekly, Issue 18, May 6, 2009

    A recent study by the Agency for Healthcare Research and Quality says that hospitals spent over $30...

CMW News: Massachusetts hospitals report more than 300 errors

  • Case Management Weekly, Issue 15, April 15, 2009

    The Department of Public Health released a report last week that says more than 300 patients in...

CMW Tip of the Week: Using Condition Code 44

  • Case Management Weekly, Issue 15, April 15, 2009

    This week’s tip, an ask the expert,  was submitted by Elaine Hall, LPN, a care...

CMW Mentor Moment: Discharging to an LTACH

  • Case Management Weekly, Issue 14, April 8, 2009

    The article below was written by Jackie Birmingham, RN, BSN, MS, CMA, and is an excerpt from...

CMW News: Medicare rehospitalizations cost $17.4 billion in 2004

  • Case Management Weekly, Issue 14, April 8, 2009

    A study recently published in The New England Journal of Medicine examined Medicare claims data...

Evaluate your facility's UR committee

  • Case Management Weekly, Issue 10, March 11, 2009

    This week’s tip comes from Karen Zander, RN, MS, CMAC, FAAN.

CMW Tip of the Week: Address one-day stays before the RAC permanent program begins

  • Case Management Weekly, Issue 7, February 18, 2009

    It is no secret that RACs focused on one-day stays in the demonstration project. So what are you...

CMW News: The RAC is back on track

  • Case Management Weekly, Issue 6, February 11, 2009

    The Centers for Medicare & Medicaid Services announced on February 6 that the contract protests...

Mastering Medicare's Important Message

  • Case Management Monthly, Issue 2, February 1, 2009

    Although many facilities struggle with delivering the Important Message (IM) from Medicare as part...

Improve patient satisfaction to enhance discharge planning

  • Case Management Monthly, Issue 2, February 1, 2009

    A patient can come into your facility and get the best care possible, but if you don't have a...

CMW Tip of the Week: How to handle Advance Beneficiary Notices of Noncoverage

  • Case Management Weekly, Issue 4, January 28, 2009

    This week’s tip comes from Jackie Birmingham, RN, BSN, MS, CMAC.

CMW News: Surgical checklist increases patient safety

  • Case Management Weekly, Issue 3, January 21, 2009

    A new study concludes that a 19-item surgical safety checklist decreased post-surgical...

CMW News: CMS issues final interim rule on durable medical equipment

  • Case Management Weekly, Issue 3, January 21, 2009

    CMS announced a temporary delay in the implementation of a competitive bidding program for durable...

Eliminate overcrowding in the ED

  • Case Management Monthly, Issue 1, January 1, 2009

    ED overcrowding is a problem almost every hospital faces. Many patients inappropriately come to the...

What role does the case manager play in coordinating and implementing core measures?

  • Case Management Monthly, Issue 1, January 1, 2009

    No longer just a Joint Commission requirement, core measures have hit everyone’s radar and...

CMW News: Hospitals around the nation look to cure ED overcrowding

  • Case Management Weekly, Issue 50, December 17, 2008

    Too many patients and not enough capacity in the emergency department has been a longstanding...

CMW News: The Joint Commission, CMS not enough to keep hospitals safe

  • Case Management Weekly, Issue 49, December 10, 2008

    The United States has difficulty penalizing or closing unsafe hospitals because it lacks a single...

CMW News: Web site helps seniors choose Medicare Part D plan

  • Case Management Weekly, Issue 48, December 3, 2008

    Now seniors and caregivers can find the most suitable and cost effective Medicare Part D plan by...

CMW News: Survey reports physician concerns regarding never events

  • Case Management Weekly, Issue 46, November 12, 2008

    On October 1, CMS began withholding additional payments to hospitals for certain identified serious...

CMW Tip of the Week: Properly document discharge plans

  • Case Management Weekly, Issue 46, November 12, 2008

    This week’s tip, an “Ask the Expert,” was provided by Karla Mariska, RN, a...

Manage your fear of the RAC

  • Case Management Monthly, Issue 11, November 1, 2008

    CMS’ Recovery Audit Contractor (RAC) program elicits feelings of fear, but Brenda Keeling...

Make advocacy and quality the focus of a comprehensive case management program

  • Case Management Monthly, Issue 11, November 1, 2008

    If your case management program is like most, it focuses mainly on utilization review and discharge...

Transforming the elective precertification process

  • Case Management Monthly, Issue 11, November 1, 2008

    The corporate care management staff at the University of Pittsburgh Medical Center (UPMC) knew its...

LOS initiative saves one facility more than $1 million

  • Case Management Monthly, Issue 10, October 1, 2008

    When New Hanover Regional Medical Center (NHRMC) in Wilmington, NC, wanted to decrease LOS...

Say yes to best practices in denial prevention

  • Case Management Monthly, Issue 10, October 1, 2008

    Today, hospitals are facing many challenges: Shrinking payer sources, increasing charity care...

Where case management sits in the POA puzzle

  • Case Management Monthly, Issue 9, September 1, 2008

    $23,772: That's the projected average annual loss per hospital starting October 1, when Medicare...