Case Management

Case Management Articles by Topic: Billing and Reimbursement

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 news: Providers report first RAC denials in Florida, South Carolina

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

    Healthcare providers are starting to share their interactions with recovery audit contractors...

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...

CMW Mentor moment: Are you paying attention to your case mix index?

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

    Hospitals use the CMI to determine the budget. If the actual CMI is lower than the budgeted CMI...

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...

CMW news: Older Americans concerned there are insufficient physicians, nurses to meet future needs

  • Case Management Weekly, Issue 37, September 16, 2009

    More than half (55%) of individuals older than 50 do not think enough physicians or nurses will be...

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...

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...

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...

CMW Tip of the Week: Use a change-of-status form to ensure condition code 44 compliance

  • Case Management Weekly, Issue 27, July 8, 2009

    A change-of-status form will help ensure that a hospital meets all of the criteria for reporting...

Case managers intervene to aid admission process

  • Case Management Monthly, Issue 7, July 1, 2009

    The goal is to comply with payer rules and provide the appropriate care to patients. As simple as...

Virtual patient advocate could reduce readmissions

  • Case Management Monthly, Issue 7, July 1, 2009

    The spotlight’s shining on readmission rates. A Commonwealth Fund–supported study...

CMW News: Drug industry agrees to fund portion of Medicare doughnut hole

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

    The Pharmaceutical Research and Manufacturers of America, following negotiations with lawmakers...

CMW News: Obama administration calls for more hospital payment cuts

  • Case Management Weekly, Issue 25, June 24, 2009

    In an effort to reform healthcare and reduce costs, President Obama has called for $313 billion in...

CMW news: Discuss patient financial information early in the hospital stay

  • Case Management Weekly, Issue 22, June 3, 2009

    The Patient Friendly Billing Project, a collaborative effort  spearheaded by the Healthcare...

Partner with hospitalists to improve patient care

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

    Hospitalist programs are becoming increasingly popular because of their specialized knowledge of...

Observation status: Tips for accurate care determination

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

    Hospitals large and small, rural and urban, face a common struggle to ensure that their patients...

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 News: Housing and care coordination reduce hospitalizations

  • Case Management Weekly, Issue 19, May 13, 2009

    Offering case management intervention and housing to homeless patients reduced hospitalizations by...

The RAC is back! How can I prepare my facility?

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

    The time is now for RAC readiness for case management departments throughout the country.

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...

CMW News: ED visits and costs rise in Massachusetts

  • Case Management Weekly, Issue 17, April 29, 2009

    Despite Massachusetts’ mandated health insurance law that became effective in 2006, ED visits...

CMW Tip of the Week: Discounts to uninsured or underinsured patients

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

    Hospitals may discount services to uninsured and underinsured patients who are unable to pay their...

Changing times call for weekend case management coverage

  • Case Management Monthly, Issue 4, April 1, 2009

    Adding weekend case management at your facility may seem like a difficult task or an unnecessary...

CMW News: One-third of patient bad debt should be classified as charity

  • Case Management Weekly, Issue 13, April 1, 2009

    A study of 148 hospitals in 2008 has identified that nearly 31% of patient revenue written off as...

CMW News: Communities cut care for undocumented immigrants

  • Case Management Weekly, Issue 12, March 25, 2009

    Many healthcare providers believe it would be better practice to spend $100 providing primary care...

CMW News: Iowa hospitals struggle in hard economic times

  • Case Management Weekly, Issue 11, March 18, 2009

    The Iowa Hospital Association (IHA) reports declines in service areas and increases in charity care...

CMW Tip of the Week: Who should receive RAC correspondence?

  • Case Management Weekly, Issue 11, March 18, 2009

    This week’s tip, an “Ask the Expert,” comes from Karen Feeley, director of...

MedPac recommends increase in 2010 hospital payments

  • Case Management Weekly, Issue 9, March 4, 2009

    The Medicare Payment Advisory Commission (MedPac) recently provided Congress with its...

CMW News: Keeping aging patients out of the hospital is harder than it seems

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

    A recent study aimed at keeping elderly patients with chronic conditions out of the hospital...

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...

CMW News: Hospitals facing extreme funding problems

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

    Nine out of 10 hospitals reported that borrowing money has become harder due to the economic...

CMW News: CMS announces demonstration sites for bundled fee-for-service payments

  • Case Management Weekly, Issue 2, January 14, 2009

    In an effort to better align the incentives for both hospitals and physicians, CMS has established...

CMW News: California bans "balance billing"

  • Case Management Weekly, Issue 2, January 14, 2009

    The California Supreme Court recently ruled that physicians can no longer bill patients for...

Improve patient advocacy by creating a managed care partnership

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

    Managed care companies are viewed as the Goliath to a case management program’s David...

CMW News: Hospitals receive different reimbursements for identical procedures

  • Case Management Weekly, Issue 47, November 26, 2008

    Some Massachusetts hospitals earn much higher rates than other hospitals in the state for...

CMW Tip of the week: Understand the difference between a Medicare appeal and a Medicare reopening

  • Case Management Weekly, Issue 46, November 19, 2008

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

CMW News: Hospitals see decline in paying patients, rise in non-paying

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

    As emergency departments are filled to capacity with patients who have no insurance or can’t...

CMW News: Palliative care programs save hospitals money

  • Case Management Weekly, Issue 45, November 5, 2008

    While palliative care is a relatively new specialty, a recent study provides more evidence of its...

CMW News: Health insurance companies urge physicians to prescribe generic drugs

  • Case Management Weekly, Issue 45, November 5, 2008

    In the past, drug companies have been criticized for encouraging physicians to prescribe their...

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...

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...

Collaboration accelerates discharge planning process

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

    St. Luke’s Episcopal Hospital in Houston had several problems in its ICU: LOS rates had...