Case Management

Case Management Articles by Topic: Leadership and Management

Mentor moment: How to implement a readmission reduction program

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

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Sneak peek: Is improper billing inflating your readmission rate?

  • Case Management Weekly, Issue 28, July 13, 2011

    Hospitals may have a higher than expected readmission rate simply because they aren't properly...

Mentor moment: CMS eyes Readmission Payment Reduction Program expansion

  • Case Management Weekly, Issue 26, June 29, 2011

    It appears that CMS is beginning to plan an expansion of the Readmission Payment Reduction Program.

Tip: Know when to take charge

  • Case Management Weekly, Issue 26, June 29, 2011

    Care coordination involves many levels of intervention.

Mentor moment: Provider-friendly change to tracking observation hours

  • Case Management Weekly, Issue 25, June 22, 2011

    In the July OPPS update, CMS made a very provider-friendly manual change to the section on counting...

Mentor moment: Communicating with physicians is the key to effective case management

  • Case Management Weekly, Issue 24, June 15, 2011

    Allow me to share a recent experience I had with a physician group regarding clinical...

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...

Tip: Align case managers with social workers

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

    For models of practice that separate case management and social work, the best advice is to make...

Sneak peek: Creative ways to improve staff morale without spending a lot of money

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

    Even with today's tight budgets, there are ways to brighten the faces of staff members. We asked a...

Mentor moment: The Partnership for Patients brings a community approach to healthcare

  • Case Management Weekly, Issue 21, May 25, 2011

    The Partnership for Patients aims to create new public and private working relationships that...

News: CDC offers tips to prepare for a zombie apocalypse

  • Case Management Weekly, Issue 21, May 25, 2011

    The Centers for Disease Control and Prevention (CDC) wants to ensure that you know what to do if...

Tip: Consult PFS when caring for patients who lack health insurance

  • Case Management Weekly, Issue 21, May 25, 2011

    ED case managers play a pivotal role for patients who are indigent, undocumented illegal...

Sneak peek: Investigate gray areas to improve patient status assignment

  • Case Management Weekly, Issue 21, May 25, 2011

    Not every patient status decision is difficult. Some are quite obvious.

Mentor moment: The four R's build a strong case management team

  • Case Management Weekly, Issue 19, May 11, 2011

    Kindred Healthcare’s long-term acute care (LTAC) hospitals use the four “R’s to...

News: States begin implementing Medicaid face-to-face requirements

  • Case Management Weekly, Issue 19, May 11, 2011

    Several states are beginning to implement Medicaid face-to-face requirements, prior to the...

Tip: Nursing documentation requirements for observation services

  • Case Management Weekly, Issue 19, May 11, 2011

    Nursing documentation for observation patients must reflect the assessment and reassessment of...

Sneak peek: Assign a surgery gatekeeper to ensure inpatient-only compliance

  • Case Management Weekly, Issue 19, May 11, 2011

    Most facilities do not have a process to check scheduled surgical procedures against the...

Mentor moment: Readmissions reduction program beginning to take shape

  • Case Management Weekly, Issue 18, May 4, 2011

    CMS has begun to lay the foundation for the coming hospital readmission reduction program as part...

Tips: Evaluate medical necessity early

  • Case Management Weekly, Issue 18, May 4, 2011

    An effective process for evaluating medical necessity of admission begins when a patient presents...

Sneak peek: CMS answers questions about the second IM

  • Case Management Weekly, Issue 18, May 4, 2011

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

Mentor moment: CMS publishes IPPS proposed rule for 2012

  • Case Management Weekly, Issue 17, April 27, 2011

    This year’s proposed rule contains the widest variety of inpatient clarifications and...

Sneak peek: Tips for educating medical staff on level of care

  • Case Management Weekly, Issue 17, April 27, 2011

    The case management department cannot improve level of care decisions without cooperation from...

Mentor moment: Understanding semi-automated RAC reviews

  • Case Management Weekly, Issue 16, April 20, 2011

    Providers familiar with automated claims reviews and complex claims reviews by recovery audit...

Tip: Case management for children with special needs

  • Case Management Weekly, Issue 8, April 20, 2011

    Children with complex medical conditions and technology dependence are frequent visitors to...

Sneak peek: Two discharge planning best practices that should be part of your process

  • Case Management Weekly, Issue 16, April 20, 2011

    Hospitals have no choice regarding discharge planning: Federal law requires that they have a...

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...

Tip: Determine patients' resources for postacute services

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

    Understanding how Medicare pays for hospital services helps discharge planners counsel patients and...

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...

Case Management Monthly is accepting submissions

  • Case Management Weekly, Issue 14, April 6, 2011

    Case Management Monthly is accepting submissions for its “Complex Case” and “From...

Mentor moment: Home health face-to-face requirement effective April 1

  • Case Management Weekly, Issue 14, April 6, 2011

    CMS Director Jonathan Blum told the Face-to-Face Workgroup that CMS expects full compliance with...

News: More patients need home health services after hospitalization

  • Case Management Weekly, Issue 14, April 6, 2011

    The number of patients who needed home health care after a hospital stay increased by nearly 70...

Tip: Hospital and discharge planner responsibilities for transfer MS-DRGs

  • Case Management Weekly, Issue 14, April 6, 2011

    Discharge planners are in a unique position to ensure accurate documentation of patients&rsquo...

Sneak peek: Percentage of case managers who received raises up from 2010

  • Case Management Weekly, Issue 14, April 6, 2011

    The following are the highlights from the 2011 Case Management Monthly Salary Survey.

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...

Tip: Patient advocacy an essential case management function

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

    Case managers should serve as advocates as patients progress through their hospital stays. Advocacy...

Sneak peek: Keep your team focused during care coordination rounds

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

    Case managers and social workers have an active role in helping patients and families make...

News: Study finds link between nursing staffing and mortality rates

  • Case Management Weekly, Issue 12, March 23, 2011

    Hospital units with RN staff below target levels have a higher mortality rate, according to a study...

Q&A: Physician's narrative of the face-to-face encounter

  • Case Management Weekly, Issue 12, March 23, 2011

    Q: What is an example of a physician's narrative of face-to-face documentation?

Sneak peek: Keep your team focused during care coordination rounds

  • Case Management Weekly, Issue 12, March 23, 2011

    Facilities that hold regular interdisciplinary care coordination rounds often say such meetings...

Mentor moment: A Salute to Case Management Social Workers

  • Case Management Weekly, Issue 11, March 16, 2011

    Happy Social Worker Month! The National Association of Social Workers’ theme for this...

News: Special ODF to address inpatient quality reporting HAC measures

  • Case Management Weekly, Issue 11, March 16, 2011

    CMS has scheduled a March 21 Open Door Forum that will focus on the hospital-acquired condition...

News: CMS increases RAC record request limit for select hospitals

  • Case Management Weekly, Issue 10, March 9, 2011

    CMS increased the number of medical records that RAC can request in a 45-day period from hospitals...

Mentor moment: CMS answers questions about the second Important Message from Medicare

  • Case Management Weekly, Issue 10, March 9, 2011

    The American Case Management Association (ACMA) received a document from CMS that answers questions...

Q&A: Delivering the second IM on the day of discharge

  • Case Management Weekly, Issue 10, March 9, 2011

    Q: If a situation requires the hospital to provide the follow-up Important Message from Medicare...

Sneak peek: Discussing palliative care requires a delicate approach

  • Case Management Weekly, Issue 10, March 9, 2011

    To relieve family members of the burden of end-of-life decisions, some patients make their wishes...

Mentor moment: Medicaid RACs are coming...someday

  • Case Management Weekly, Issue 9, March 2, 2011

    CMS has instructed Medicaid agencies to develop Medicaid recovery audit contractor (RAC) programs...

News: Obama signs new healthcare reform provision

  • Case Management Weekly, Issue 9, March 2, 2011

    Recent legislation signed into law by President Obama allows states to opt out of certain...

Tip: Preadmission utilization review

  • Case Management Weekly, Issue 9, March 2, 2011

    Case management involvement in preadmission utilization review is essential.

Sneak peek: Deduct active monitoring time to bill observation appropriately

  • Case Management Weekly, Issue 9, March 2, 2011

    Observation services are a specific set of services provided to a patient while the physician...

Create a compliant condition code 44 process

  • Case Management Monthly, Issue 3, March 1, 2011

    CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it...

Case Management Monthly, March 2011

  • Case Management Monthly, Issue 3, March 1, 2011

    This issue of Case Management Monthly features articles about counting billable observation hours...

Mentor moment: Case management protocol is still debatable

  • Case Management Weekly, Issue 8, February 23, 2011

    CMS reiterated in SE1037 that inpatient screening tools may assist facilities in making patient...

News: CMS announces electronic data submission tool

  • Case Management Weekly, Issue 8, February 23, 2011

    CMS has announced its "esMD" (electronic submission of medical documentation) program...

Q&A: Backdating an inpatient admission

  • Case Management Weekly, Issue 8, February 23, 2011

    Q: A patient receives observation services following an emergency department (ED) stay, but the...

Sneak peek: Create a compliant condition code 44 process

  • Case Management Weekly, Issue 8, February 23, 2011

    Facilities that use condition code 44 often can take that as a sign that they have a poor inpatient...

Mentor moment: Think of case management as a proactive team

  • Case Management Weekly, Issue 7, February 16, 2011

    Discharges occur; assessing patients for discharge needs and communicating with the physician team...

News: Alarm fatigue affects nurses, patients

  • Case Management Weekly, Issue 7, February 16, 2011

    Between January 2005 and June 2010, more than 200 hospital patients died because nurses did not...

Q&A: Average LOS for specific MS-DRGs?

  • Case Management Weekly, Issue 7, February 16, 2011

    Q: Should discharge planners know the average LOS for specific MS-DRGs?

Sneak peek: Be assertive when communicating with physicians

  • Case Management Weekly, Issue 7, February 16, 2011

    As patient advocates, case managers often need to question physician decisions that do not follow...

Tip: Define departmental philosophy

  • Case Management Weekly, Issue 6, February 9, 2011

    Answering to the following philosophical questions influence the type of model developed and FTE...

News: More patients scheduling ED appointments

  • Case Management Weekly, Issue 5, February 2, 2011

    Several hospitals have taken advantage of an online preregistration and check-in service that...

Tip: Use professional judgment when disclosing patient information

  • Case Management Weekly, Issue 5, February 2, 2011

    Discharge planners should use professional judgment when deciding whether to share medical or...

Sneak peek: Pay attention to transfer DRGs and discharge status codes

  • Case Management Weekly, Issue 5, February 2, 2011

    There are specific MS-DRGs, called transfer DRGs, that can trigger certain transfer rules that...

Mentor moment: Decrease length of stay through communication and collaboration

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

    If you are not communicating as a team, you will not be successful in decreasing LOS. And in the...

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...

Tip: Arrange transportation for ED patients

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

    ED case manager should try, with the patient’s help, to call family, friends, or neighbors...

Sneak peek: SBAR method improves communication across units

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

    Methodist South Hospital in Memphis, TN, began using the SBAR tool to meet two basic needs...

Mentor moment: CMS issues proposed rule on value-based incentive payments to acute care hospitals under the IPPS

  • Case Management Weekly, Issue 3, January 19, 2011

    CMS published a proposed rule to provide value-based incentive payments to those acute care...

Tip: Evaluate caregivers' ability to perform necessary tasks at home

  • Case Management Weekly, Issue 3, January 19, 2011

    Caregivers help patients transition from hospitals in several ways, including, but not limited to...

Sneak peek: Family info group takes proactive approach in teaching families ICU basics

  • Case Management Weekly, Issue 3, January 19, 2011

    Families often have to make difficult decisions when a loved one is in the ICU, and they rely on...

Tip: Partnering with finance department benefits case management

  • Case Management Weekly, Issue 2, January 12, 2011

    Case management’s many ties to the organization’s financial status make establishing...

Mentor moment: Applying for the Community-Based Care Transitions Program

  • Case Management Weekly, Issue 1, January 5, 2011

    The Community-Based Care Transitions Program demonstration project will fund efforts to improve...

Sneak peek: Team struggles to arrange outpatient dialysis treatment for noncompliant patient

  • Case Management Weekly, Issue 1, January 5, 2011

    Gerald is a 47-year-old male with a history of drug abuse and suicide attempts. He also presents to...

Case Management Monthly January 2011

  • Case Management Monthly, Issue 1, January 1, 2011

    This issue of Case Management Monthly features articles on patient choice, observation services...

Patient choice is about quality, not quantity

  • Case Management Monthly, Issue 1, January 1, 2011

    Medicare guidelines state that patients must be given a choice when it comes to their discharge...

Clinical protocols improve throughput at children's hospital

  • Case Management Monthly, Issue 1, January 1, 2011

    In an effort to enhance outcomes and standardize practice in pediatric patients, Children’s...

Work with bed flow coordinators to improve throughput

  • Case Management Monthly, Issue 1, January 1, 2011

    Bed flow coordinators and case managers must work together to ensure proper patient throughput.

Team struggles to arrange outpatient dialysis treatment for noncompliant patient

  • Case Management Monthly, Issue 1, January 1, 2011

    Gerald is a 47-year-old male with a history of drug abuse and suicide attempts. He also presents to...

Mentor moment: Communicate with coders to assign proper discharge codes

  • Case Management Weekly, Issue 51, December 22, 2010

    Proper assignment of discharge codes can make a big difference in a hospital’s reimbursement...

News: ED administrators say decreased mental health funding leads to overcrowding

  • Case Management Weekly, Issue 51, December 22, 2010

    A significant gap in services for mental health patients has led to emergency department (ED...

Tip: Create a guide to home healthcare referrals for off-hours

  • Case Management Weekly, Issue 51, December 22, 2010

    The success of any emergency department case management program includes easy around-the-clock...

Sneak peek: ACE-ing care transitions means blending utilization review and discharge planning tactics

  • Case Management Weekly, Issue 51, December 22, 2010

    Finding a common tool that organizes the discharge process into a framework may provide for a more...

News: Tele-ICU technology can cut LOS and decrease mortality

  • Case Management Weekly, Issue 50, December 15, 2010

    Telemedicine technology can address staffing shortages in the intensive care unit (ICU), while...

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...

Strengthen postacute relationships to prepare for healthcare reform

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

    One of the more talked-about initiatives in the Patient Protection and Affordable Care Act is the...

Mentor moment: Medical necessity takes on new meaning

  • Case Management Weekly, Issue 48, December 1, 2010

    The concept of medical necessity takes on new meaning and significance when you consider the recent...

News: CMS requests comments on ACO program

  • Case Management Weekly, Issue 48, December 1, 2010

    CMS wants comments from physicians and other healthcare providers as it develops a proposed rule...

Tip: Use FISS to track Medicare benefit days

  • Case Management Weekly, Issue 48, December 1, 2010

    Tracking use of services by Medicare beneficiaries is a complex process, but the Fiscal...

Sneak peek: Effective physician advisors enhance documentation

  • Case Management Weekly, Issue 48, December 1, 2010

    The rules for making proper level-of-care decisions are lengthy and confusing, which makes the role...

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...

News: One in ten hospital admissions is preventable

  • Case Management Weekly, Issue 45, November 10, 2010

    In 2008, one out of every ten hospital stays was potentially preventable, according to a report...

Tip: Examine where patients come from when determining UR staff allocation

  • Case Management Weekly, Issue 43, November 10, 2010

    The initial utilization review (UR) lays the groundwork necessary to maximize the approval of...

Mentor moment: Hospital leaders consider case management a top priority

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

    Community hospital CEOs and C-suite executives consider case management the second most important...

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...

Dispute inappropriately denied readmissions

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

    Several case managers have recently received denial letters from their regions’ Medicare...

Mentor moment: CMS says providers cannot use condition code 44 to backdate observation services

  • Case Management Weekly, Issue 38, September 22, 2010

    CMS issued a transmittal that explicitly states providers may not use condition code 44 to...

News: Sebelius warns insurers against unjustified rate hikes

  • Case Management Weekly, Issue 38, September 22, 2010

    U.S. Department of Health and Human Services Secretary Kathleen Sebelius wrote America’s...

Mentor moment: Providers ask CMS to abolish observation services

  • Case Management Weekly, Issue 36, September 8, 2010

    Several providers suggested CMS abolish observation services during an August 24 CMS listening...

Sneak peek: Private care managers advocate for patients after discharge

  • Case Management Weekly, Issue 36, September 8, 2010

    Private care managers help geriatric patients who have complex care needs such as coordination...

Protect patient information when communicating with payers

  • Case Management Monthly, Issue 9, September 1, 2010

    The U.S. Department of Health and Human Services (HHS) proposed modifications to the HIPAA Privacy...

What are the consequences of LOS reduction?

  • Case Management Monthly, Issue 9, September 1, 2010

    Many of us dream of the day when our department achieves its targeted LOS; however, LOS perfection...

'Ticket to Home' tool helps patients and families prepare for discharge

  • Case Management Monthly, Issue 9, September 1, 2010

    The case management department at Children’s Healthcare of Atlanta (CHOA) developed a tool...

Measure department effectiveness beyond LOS

  • Case Management Monthly, Issue 9, September 1, 2010

    Hospital executives frequently use LOS to measure how well a case management staff performs, but...

Mentor moment: Communication between physicians and case managers reduces patient risk

  • Case Management Weekly, Issue 35, September 1, 2010

    Ongoing communication and collaboration between physicians, nurses, and case managers is essential...

Sneak peek: Take UR out of case management

  • Case Management Weekly, Issue 35, September 1, 2010

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

Mentor moment: Tailor discharge instructions to your patients' needs

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

    The issue of readmissions isn’t new, but the attention it’s receiving is. With new...

News: California launches nations' largest telehealth network

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

    California Governor Arnold Schwarzenegger and U.S. Chief Technology Officer Aneesh Chopra announced...

Sneak peek: Measure department effectiveness beyond LOS

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

    Hospital executives frequently use LOS to measure how well a case management staff performs, but...

Mentor moment: Address fragmented care to prevent readmission denials

  • Case Management Weekly, Issue 33, August 18, 2010

    Hospitals that admit patients for services that should have been provided during an earlier...

News: Region B RAC posts first set of medical necessity issues

  • Case Management Weekly, Issue 33, August 18, 2010

    CGI Technologies and Solutions, Inc., of Fairfax, VA, the Region B recovery audit contractor (RAC...

Tip: Working with patients who have low health literacy

  • Case Management Weekly, Issue 33, August 18, 2010

    Consider these tips when working with patients who have limited health literacy

Mentor moment: The Lean Six Sigma process applied to case management

  • Case Management Weekly, Issue 31, August 4, 2010

    Case managers can join the various industry leaders that have used the Lean process to reduce waste...

Tip: Schedule regular staff meetings

  • Case Management Weekly, Issue 31, August 4, 2010

    Case management departments should discuss reports that address the following topics at staff...

News: Higher readmission rate possible consequence of successful care

  • Case Management Weekly, Issue 29, July 21, 2010

    Researchers from the Cleveland Clinic suggest that 30-day readmissions are not an accurate...

Tip: Steps in the discharge planning process

  • Case Management Weekly, Issue 29, July 21, 2010

    Both discharge planning and transitional planning apply a process whereby a systematic approach...

Sneak peek: Team-based case management improves navigation

  • Case Management Weekly, Issue 29, July 21, 2010

    At Cabell Huntington (WV) Hospital (CHH), case managers are more than just chart reviewers, they...

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...

Sneak peek: Long-term acute care hospital system partners with university to combat case manager shortage

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

    Recruitment, retention, and turnover are challenging in any profession. Case management is no...

Mentor moment: CMS update indicates high provider success rate for appealing denials

  • Case Management Weekly, Issue 27, July 7, 2010

    A recent CMS report indicates that providers have been winning more appeals since the last update.

Sneak peek: Case management helps with the ABN process

  • Case Management Weekly, Issue 27, July 7, 2010

    In most facilities, the patient access staff is in charge of the ABN process. However, most patient...

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...

Position your department for payment reform

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

    In March, President Obama signed the Patient Protection and Affordable Care Act into law. Although...

Hospitals team up to tackle frequent ED visitors

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

    Unlike politicians who only give lip service to working with rivals, BryanLGH and Saint Elizabeth...

Consider alternative resources in rural communities

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

    In an environment of limited resources, ensuring care for patients post-discharge can challenge any...

Tip: Address caregivers' comfort

  • Case Management Weekly, Issue 24, June 16, 2010

    Patient or family inconvenience can be a significant factor affecting length of stay, especially...

Sneak peek: Denial prevention via records and contract language

  • Case Management Weekly, Issue 22, June 2, 2010

    Documentation by the medical staff is a pillar of reimbursement success.

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...

What does case-mix index mean to you?

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

    Case managers can do their part to make sure their hospital's case-mix index is as high as possible.

Checklist tool helps staff evaluate the entire patient, identify readmissions

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

    Case managers at Jennie Edmundson use an assessment tool to identify patients that are at a...

Denial prevention via records and contract language

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

    Denial prevention begins by establishing channels that lead to a systematic review of each...

Mentor moment: Improve PASRR processes to prepare for healthcare reform

  • Case Management Weekly, Issue 21, May 26, 2010

    Healthcare reform will increase the number of nursing facility referrals. Hospitals must improve...

Sneak peek: Checklist tool helps staff evaluate entire patient, identify readmissions

  • Case Management Weekly, Issue 21, May 26, 2010

    Before creating and implementing the Discharge Planning for Social Work Referral tool, Jennie...

News: HIPAA violator sentenced to prison

  • Case Management Weekly, Issue 18, May 5, 2010

    A former UCLA Healthcare System employee will serve four months in prison for snooping at...

Case Management Monthly May 2010

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

    Inside: The results are in: 2010 case management salary survey Identify your...

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...

Identify your department's revenue cycle risk; ensure adequate staffing

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

    Use data to identify weakness in your case management department processes and reduce revenue cycle...

Communication with CDI professionals can help meet common goals

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

    No matter whom the CDI department reports to, collaboration between case managers and CDI...

Mentor moment: Do case managers communicate effectively?

  • Case Management Weekly, Issue 17, April 28, 2010

    The case manager’s main goal is coordinating care and collaborating with other members of the...

News: iPad facilitates patient education

  • Case Management Weekly, Issue 17, April 28, 2010

    St. Luke's Health System in Boise, ID is proving that Apple’s new iPad™ isn’t...

Q&A: Changing hospital culture

  • Case Management Weekly, Issue 17, April 28, 2010

    Q: How can we change the hospital culture to make case management easier to do day after day?

Sneak peek: The 2010 case management salary survey results are in

  • Case Management Weekly, Issue 17, April 28, 2010

    Despite the struggling economy, more than half of survey respondents (62%) reported that they...

Mentor moment: ED case management and CDI will lead to better medical necessity documentation

  • Case Management Weekly, Issue 16, April 21, 2010

    A case management presence in your ED will help physicians better understand medical necessity...

Tip: Don't include UM documentation in the medical record

  • Case Management Weekly, Issue 16, April 21, 2010

    UM documentation is not clinical documentation and should not be available to anyone requesting the...

Sneak peek: The 2010 case management salary survey results are in

  • Case Management Weekly, Issue 14, April 7, 2010

    Despite the struggling economy, more than half of survey respondents (62%) reported that they...

Case Management Monthly April 2010

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

    Inside: ACE demonstration improves care coordination and lowers costs How can discharge...

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...

See the discharge process through the patient's eyes

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

    Case managers and discharge must understand patients’ perspective to make sure patients...

Integration of mental and physical treatment leads to improved patient outcomes

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

    Untreated mental conditions can prevent patients from properly managing physical health, thus...

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...

Mentor moment: Proactive discharge planning

  • Case Management Weekly, Issue 12, March 24, 2010

    Improved patient care starts with relationships. Hospital case managers and social workers must...

Sneak peek: Integration of mental and physical treatment leads to improved patient outcomes

  • Case Management Weekly, Issue 12, March 24, 2010

    Recognizing how this population’s mental health contributes to their physical health goes a...

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: See the discharge process through the patient’s eyes

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

    The advent of the DRG system gave hospitals an incentive to decrease LOS. The average LOS is two...

Q&A: How to evaluate a discharge planning process

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

    Q: How can a hospital evaluate or asses its discharge planning process?

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...

Case Management Monthly March 2010

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

    Inside: ACE demonstration improves care coordination and lowers costs How can discharge planning...

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...

How can discharge planning prevent readmissions?

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

    The case manager must examine every component of the discharge process for opportunities for...

Ten steps to implementing ED case management

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

    At this juncture in the evolution of case management services, we have reached the tipping point of...

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...

Mentor moment: What meaningful use means to case management: Stage 1

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

    Implementation of the proposed Stage 1 criteria for meaningful use could directly impact daily case...

Sneak peek: Interstate transfers create financial, logistical challenges

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

    One of the biggest challenges of executing an interstate transfer is the cost, says Matt Boettcher...

Mentor moment: Understanding CERT helps address clinical documentation deficiencies

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

    There appears to be a misconception among physicians that clinical documentation is for the benefit...

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...

Sneak peek: ACE demonstration improves care coordination and lowers costs

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

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

Mentor moment: Addressing mental health issues improves patients' physical health

  • Case Management Weekly, Issue 5, February 3, 2010

    Poor communication between physicians who treat physical issues and providers who treat mental...

Tip: Factors to consider before admitting a patient

  • Case Management Weekly, Issue 5, February 3, 2010

    Consider the following when deciding whether to admit a patient:

Sneak peek: Daily flash rounds improve interdepartment communication

  • Case Management Weekly, Issue 5, February 3, 2010

    Case managers at Greenville Hosptial System needed a better system for communicating with staff...

Daily flash rounds improve interdepartment communication

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

    The daily flash rounds meeting at Greenville Hospital System is a quick, informal meeting that...

Case Management Monthly, February 2010

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

    Inside: Your condition code 44 questions answered Milliman or InterQual: Which product is right...

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 mentor moment: Study finds discharge planning measures don?t reduce readmissions

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

    A new study published in the New England Journal of Medicine says improving publicly reported...

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 news: Study says House version of healthcare reform bill will cover 24 million uninsured

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

    By 2019, 24 million currently uninsured individuals will have healthcare coverage if the House...

CMW sneak peek: How can I reduce my facility’s readmission rate?

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

    Medicare has not established a target date for any changes in payment methodology, but some of the...

CMW mentor moment: Length of stay should not be a secret

  • Case Management Weekly, Issue 1, January 6, 2010

    Hospital organizations need to realize and act upon the fact that discharge planning begins at the...

CMW tip: Consider multiple physician advisors

  • Case Management Weekly, Issue 1, January 6, 2010

    In most hospitals, the physician advisor should be available every day, at least on an on-call...

CMW sneak peek: Study shows barriers to reducing 30-day readmissions

  • Case Management Weekly, Issue 1, January 6, 2010

    Results of a nine-month HCPro transition-of-care study, available on CaseManagementMentor.com...

Study shows barriers to reducing 30-day readmissions

  • Case Management Monthly, Issue 1, January 1, 2010

    Results of a nine-month HCPro transition of care study illustrate the efforts of hospitals and SNFs...

Transfer agreements protect specialized medical centers and patients

  • Case Management Monthly, Issue 1, January 1, 2010

    Facilities that accept direct admissions for specialized services should consider creating a...

Case Management Monthly, January 2010

  • Case Management Monthly, Issue 1, January 1, 2010

    Inside: RapidView provides real-time snapshots of facility Study shows barriers to reducing...

CMW news: Number of nursing school applicants up 3.5%

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

    Enrollment in entry-level baccalaureate nursing programs increased 3.5% in 2009; however, nearly...

Traveling exposes case manager to many models

  • Case Management Monthly, Issue 12, December 1, 2009

    Travel nursing is ideal for healthcare professionals who want to explore the country while...

Case Management Monthly, December 2009

  • Case Management Monthly, Issue 12, December 1, 2009

    Inside: Clearing up condition code 44 confusion What are some innovative ways case managers can...

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...

Case Management Monthly, November 2009

  • Case Management Monthly, Issue 11, November 1, 2009

    Inside: Clearing up condition code 44 confusion What are some innovative ways case managers can...

Case Management Monthly, October 2009

  • Case Management Monthly, Issue 10, October 1, 2009

    Answers to your questions about dealing with undocumented patients Process tips from your peers...

Case Management Monthly, September 2009

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

    Inside: One facility re-develops an assessment tool to ensure documentation What are the benefits...

Recruit and retain staff for top-notch case management

  • Case Management Monthly, Issue 8, August 1, 2009

    Carolinas Medical Center (CMC) in Charlotte, NC, didn’t have a big problem with turnover...

Case Management Monthly, August 2009

  • Case Management Monthly, Issue 8, August 1, 2009

    Expediting discharges with a case manager-nurse practitioner model How CMS’ 9th Scope of...

Case Management Monthly, July 2009

  • Case Management Monthly, Issue 7, July 12, 2009

    Inside: Virtual patient advocate could reduce readmissions Case managers intervene to aid...

Managing long LOS patients

  • Case Management Monthly, Issue 6, June 1, 2009

    There are several reasons that some patients end up staying in the hospital for long amounts of...

Case Management Monthly, June 2009

  • Case Management Monthly, Issue 6, June 1, 2009

    Inside: Observation status: Tips for accurate care determination Partner with hospitalists to...

CMW Tip of the Week: Free physician advisor tools

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

    Take advantage of two free tools—courtesy of the Association of Clinical Documentation...

CMW Tip of the Week: Know when to set up a care team meeting

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

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

Case management's role in managing denials

  • Case Management Monthly, Issue 5, May 1, 2009

    A comprehensive understanding of hospital denials and their root causes will not only avoid...

Determining accurate caseloads

  • Case Management Monthly, Issue 5, May 1, 2009

    When case management caseloads become unmanageable, mistakes inevitably occur.

Case Management Monthly, May 2009

  • Case Management Monthly, Issue 5, May 1, 2009

    Case Management Monthly, an 8-page monthly newsletter, is a one-of-a-kind training, support, and...

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: Case management weekend coverage

  • Case Management Weekly, Issue 5, February 4, 2009

    This week’s tip, an Ask the Expert, was submitted by a Case Management Weekly reader and...

How case management fits into the organization

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

    Case management is an invaluable part of a hospital, but how is it recognized by the...

CMW Tip of the Week: Standardize physician level of care orders

  • Case Management Weekly, Issue 1, January 7, 2009

    This week’s tip is provided by Deborah K. Hale, CCS.  

Taking an interdisciplinary approach to attacking avoidable days

  • Case Management Monthly, Issue 12, December 1, 2008

    As facilitators and coordinators of patient care services, case managers are in the best position...

Maximizing your PA program: How one facility uses PAs to create a team approach to patient care

  • Case Management Monthly, Issue 12, December 1, 2008

    If you are not taking advantage of the expertise your physician advisor (PA) can offer to your case...

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...

Ask June

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

    Hospitalists, who specialize in the management of hospitalized patients, take over for PCPs when...