Case Management Articles by Topic: Billing and Reimbursement
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Case Management Weekly, Issue 47, November 21, 2012
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Case Management Weekly, Issue 46, November 14, 2012
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Case Management Weekly, Issue 46, November 14, 2012
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Case Management Weekly, Issue 45, November 7, 2012
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Case Management Weekly, Issue 43, October 24, 2012
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Case Management Weekly, Issue 40, October 3, 2012
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Case Management Weekly, Issue 28, July 13, 2011
Don’t make the mistake of submitting a provider liable claim because a case doesn’t...
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Case Management Weekly, Issue 28, July 13, 2011
Hospitals may have a higher than expected readmission rate simply because they aren't properly...
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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...
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Case Management Weekly, Issue 24, June 15, 2011
Allow me to share a recent experience I had with a physician group regarding clinical...
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Case Management Weekly, Issue 21, May 25, 2011
Not every patient status decision is difficult. Some are quite obvious.
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Case Management Weekly, Issue 19, May 11, 2011
Nursing documentation for observation patients must reflect the assessment and reassessment of...
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Case Management Weekly, Issue 19, May 11, 2011
Most facilities do not have a process to check scheduled surgical procedures against the...
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Compliance Monitor, Issue 18, May 4, 2011
Shirlene Reese Boone of Murfreesboro, NC, will serve 12 years in prison followed by three...
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Case Management Weekly, Issue 18, May 4, 2011
CMS released a recovery audit contractor (RAC) update about total improper payments since the RAC...
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Case Management Weekly, Issue 18, May 4, 2011
An effective process for evaluating medical necessity of admission begins when a patient presents...
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Case Management Weekly, Issue 17, April 27, 2011
This year’s proposed rule contains the widest variety of inpatient clarifications and...
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Case Management Weekly, Issue 8, April 20, 2011
The Partnership for Patients is a national partnership that aims to save 60,000 lives by stopping...
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Case Management Weekly, Issue 15, April 13, 2011
The April 7 issue of the Federal Register includes the long-awaited proposed rule that would...
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Case Management Weekly, Issue 15, April 13, 2011
Understanding how Medicare pays for hospital services helps discharge planners counsel patients and...
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Case Management Weekly, Issue 13, March 30, 2011
CMS’ Medicare Learning Network® has released the first in a series of podcasts designed...
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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...
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Case Management Weekly, Issue 9, March 2, 2011
CMS has instructed Medicaid agencies to develop Medicaid recovery audit contractor (RAC) programs...
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Case Management Weekly, Issue 9, March 2, 2011
Observation services are a specific set of services provided to a patient while the physician...
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Case Management Monthly, Issue 3, March 1, 2011
CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it...
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Case Management Monthly, Issue 3, March 1, 2011
Observation services are a specific set of services provided to a patient while the physician...
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Case Management Weekly, Issue 8, February 23, 2011
CMS reiterated in SE1037 that inpatient screening tools may assist facilities in making patient...
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Case Management Weekly, Issue 8, February 23, 2011
CMS has announced its "esMD" (electronic submission of medical documentation) program...
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Case Management Weekly, Issue 8, February 23, 2011
Q: A patient receives observation services following an emergency department (ED) stay, but the...
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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...
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Case Management Weekly, Issue 6, February 9, 2011
Observation services are a specific set of services provided to a patient while the physician...
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Case Management Weekly, Issue 5, February 2, 2011
In order to clear up any confusion about inpatient admissions, CMS issued a special edition MLN...
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Case Management Weekly, Issue 5, February 2, 2011
There are specific MS-DRGs, called transfer DRGs, that can trigger certain transfer rules that...
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Case Management Weekly, Issue 4, January 26, 2011
“Acute Care Hospital Inpatient Prospective Payment System” is now available in print...
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Case Management Weekly, Issue 4, January 26, 2011
ED case manager should try, with the patient’s help, to call family, friends, or neighbors...
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Case Management Monthly, Issue 1, January 1, 2011
In a recent HCPro audio conference titled “ Observation Services v. Inpatient Admission...
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Case Management Weekly, Issue 51, December 22, 2010
Proper assignment of discharge codes can make a big difference in a hospital’s reimbursement...
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Case Management Weekly, Issue 50, December 15, 2010
The results of HCPro’s second annual “RAC Preparedness Benchmarking Report” are...
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Case Management Weekly, Issue 49, December 8, 2010
After years of discussion and attention given to observation services and inpatient status, there...
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Case Management Weekly, Issue 49, December 8, 2010
A two-step approach may be helpful when reviewing the medical necessity of an inpatient denial.
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Case Management Monthly, Issue 12, December 1, 2010
Inside:
Strengthen postacute relationships to prepare for healthcare reform
Handling IV...
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Case Management Monthly, Issue 12, December 1, 2010
The rules for making proper level-of-care decisions are lengthy and confusing, which makes the role...
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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...
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Case Management Monthly, Issue 12, December 1, 2010
A hospital case management team digs into a patient's past to uncover information to help create a...
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Case Management Weekly, Issue 48, December 1, 2010
The concept of medical necessity takes on new meaning and significance when you consider the recent...
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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...
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Case Management Weekly, Issue 45, November 10, 2010
CMS released the long-anticipated proposed rule for Medicaid recovery audit contractors (RACs...
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Case Management Monthly, Issue 11, November 1, 2010
CMS has seen an increase in the number of extended observation stays and wants to know why. That...
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Case Management Weekly, Issue 41, October 13, 2010
One-day stays are common problem areas that are easy for RACs to target. Make sure your UR...
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Case Management Weekly, Issue 41, October 13, 2010
Some providers think CMS can eliminate extended observation stays by eliminating observation...
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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...
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Case Management Weekly, Issue 38, September 22, 2010
CMS issued a transmittal that explicitly states providers may not use condition code 44 to...
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Case Management Weekly, Issue 37, September 15, 2010
The recovery audit contractors (RAC) have certainly been busy lately. CMS gave permission to three...
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Case Management Weekly, Issue 37, September 15, 2010
Several case managers recently have received readmission denial letters from their regions&rsquo...
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Case Management Weekly, Issue 36, September 8, 2010
Several providers suggested CMS abolish observation services during an August 24 CMS listening...
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Case Management Weekly, Issue 35, September 1, 2010
Ongoing communication and collaboration between physicians, nurses, and case managers is essential...
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Case Management Weekly, Issue 29, July 21, 2010
CMS recently released a special edition MLN Matters article that provides information about...
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Case Management Weekly, Issue 27, July 7, 2010
A recent CMS report indicates that providers have been winning more appeals since the last update.
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Case Management Weekly, Issue 27, July 7, 2010
Understanding how hospitals receive payment for the care provided to patients helps case managers...
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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...
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Case Management Weekly, Issue 22, June 2, 2010
During this 90-minute audio conference our speaker will discuss government regulations and guidance...
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Case Management Weekly, Issue 22, June 2, 2010
Documentation by the medical staff is a pillar of reimbursement success.
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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.
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Case Management Weekly, Issue 18, May 5, 2010
A former UCLA Healthcare System employee will serve four months in prison for snooping at...
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Case Management Weekly, Issue 18, May 5, 2010
Hospitals have options when it comes to documenting that the patient was given a choice of...
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Case Management Monthly, Issue 5, May 1, 2010
Inside:
The results are in: 2010 case management salary survey
Identify your...
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Case Management Monthly, Issue 4, April 1, 2010
Inside:
ACE demonstration improves care coordination and lowers costs
How can discharge...
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Case Management Monthly, Issue 3, March 1, 2010
Inside:
ACE demonstration improves care coordination and lowers costs
How can discharge planning...
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Case Management Monthly, Issue 3, March 1, 2010
When executing an interstate transfer, case managers must account for different Medicaid programs...
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Case Management Weekly, Issue 8, February 24, 2010
Recovery Audit Contractors (RACs) referred only two cases of potential fraud to CMS during the RAC...
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Case Management Weekly, Issue 8, February 24, 2010
One of the biggest challenges of executing an interstate transfer is the cost, says Matt Boettcher...
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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...
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Case Management Weekly, Issue 6, February 10, 2010
Instead of paying for hospital and physician services separately, the ACE demonstration program...
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Case Management Weekly, Issue 5, February 3, 2010
Consider the following when deciding whether to admit a patient:
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Case Management Monthly, Issue 2, February 1, 2010
Inside:
Your condition code 44 questions answered
Milliman or InterQual: Which product is right...
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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...
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Case Management Weekly, Issue 3, January 20, 2010
In a recent HCPro audio conference titled “Condition Code 44 and the Utilization Review...
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Case Management Weekly, Issue 2, January 13, 2010
Essentially ACE changes how Medicare pays for healthcare services. Instead of paying the hospital...
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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...
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Case Management Weekly, Issue 1, January 6, 2010
Hospital organizations need to realize and act upon the fact that discharge planning begins at the...
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Case Management Monthly, Issue 1, January 1, 2010
In June 2009, HCPro launched a benchmarking survey of recovery audit contractor (RAC) preparation...
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Case Management Monthly, Issue 1, January 1, 2010
June Stark, RN, BSN, MEd, lists critical interventions that help prevent readmissions and can be...
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Case Management Monthly, Issue 1, January 1, 2010
Inside:
RapidView provides real-time snapshots of facility
Study shows barriers to reducing...
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Case Management Weekly, Issue 49, December 9, 2009
Connolly Healthcare has announced the first issues approved for complex RAC review, and providers...
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Case Management Monthly, Issue 12, December 1, 2009
Inside:
Clearing up condition code 44 confusion
What are some innovative ways case managers can...
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Case Management Weekly, Issue 30, November 18, 2009
Healthcare providers are starting to share their interactions with recovery audit contractors...
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Case Management Monthly, Issue 11, November 1, 2009
Inside:
Clearing up condition code 44 confusion
What are some innovative ways case managers can...
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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...
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Case Management Monthly, Issue 10, October 1, 2009
Answers to your questions about dealing with undocumented patients
Process tips from your peers...
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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...
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Case Management Monthly, Issue 9, September 1, 2009
Inside: One facility re-develops an assessment tool to ensure documentation What are the benefits...
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Case Management Monthly, Issue 9, September 1, 2009
Do you ever wonder how the postacute transfer rule will affect the reimbursement for a particular...
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Case Management Monthly, Issue 8, August 1, 2009
Expediting discharges with a case manager-nurse practitioner model
How CMS’ 9th Scope of...
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Case Management Monthly, Issue 7, July 12, 2009
Inside:
Virtual patient advocate could reduce readmissions
Case managers intervene to aid...
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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...
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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...
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Case Management Monthly, Issue 7, July 1, 2009
The spotlight’s shining on readmission rates. A Commonwealth Fund–supported study...
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Case Management Weekly, Issue 26, July 1, 2009
The Pharmaceutical Research and Manufacturers of America, following negotiations with lawmakers...
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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...
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Case Management Weekly, Issue 22, June 3, 2009
The Patient Friendly Billing Project, a collaborative effort spearheaded by the Healthcare...
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Case Management Monthly, Issue 6, June 1, 2009
Hospitalist programs are becoming increasingly popular because of their specialized knowledge of...
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Case Management Monthly, Issue 6, June 1, 2009
Hospitals large and small, rural and urban, face a common struggle to ensure that their patients...
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Case Management Monthly, Issue 6, June 1, 2009
Inside:
Observation status: Tips for accurate care determination
Partner with hospitalists to...
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Case Management Weekly, Issue 19, May 13, 2009
Offering case management intervention and housing to homeless patients reduced hospitalizations by...
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Case Management Monthly, Issue 5, May 1, 2009
The time is now for RAC readiness for case management departments throughout the country.
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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...
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Case Management Weekly, Issue 17, April 29, 2009
Despite Massachusetts’ mandated health insurance law that became effective in 2006, ED visits...
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Case Management Weekly, Issue 14, April 8, 2009
Hospitals may discount services to uninsured and underinsured patients who are unable to pay their...
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Case Management Monthly, Issue 4, April 1, 2009
Adding weekend case management at your facility may seem like a difficult task or an unnecessary...
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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...
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Case Management Weekly, Issue 12, March 25, 2009
Many healthcare providers believe it would be better practice to spend $100 providing primary care...
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Case Management Weekly, Issue 11, March 18, 2009
The Iowa Hospital Association (IHA) reports declines in service areas and increases in charity care...
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Case Management Weekly, Issue 11, March 18, 2009
This week’s tip, an “Ask the Expert,” comes from Karen Feeley, director of...
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Case Management Weekly, Issue 9, March 4, 2009
The Medicare Payment Advisory Commission (MedPac) recently provided Congress with its...
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Case Management Weekly, Issue 7, February 18, 2009
A recent study aimed at keeping elderly patients with chronic conditions out of the hospital...
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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...
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Case Management Weekly, Issue 6, February 11, 2009
The Centers for Medicare & Medicaid Services announced on February 6 that the contract protests...
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Case Management Weekly, Issue 4, January 28, 2009
Nine out of 10 hospitals reported that borrowing money has become harder due to the economic...
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Case Management Weekly, Issue 2, January 14, 2009
In an effort to better align the incentives for both hospitals and physicians, CMS has established...
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Case Management Weekly, Issue 2, January 14, 2009
The California Supreme Court recently ruled that physicians can no longer bill patients for...
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Case Management Monthly, Issue 1, January 1, 2009
Managed care companies are viewed as the Goliath to a case management program’s David...
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Case Management Weekly, Issue 47, November 26, 2008
Some Massachusetts hospitals earn much higher rates than other hospitals in the state for...
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Case Management Weekly, Issue 46, November 19, 2008
This week’s tip is provided by Deborah K. Hale, CCS.
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Case Management Weekly, Issue 46, November 12, 2008
As emergency departments are filled to capacity with patients who have no insurance or can’t...
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Case Management Weekly, Issue 45, November 5, 2008
While palliative care is a relatively new specialty, a recent study provides more evidence of its...
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Case Management Weekly, Issue 45, November 5, 2008
In the past, drug companies have been criticized for encouraging physicians to prescribe their...
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Case Management Monthly, Issue 11, November 1, 2008
CMS’ Recovery Audit Contractor (RAC) program elicits feelings of fear, but Brenda Keeling...
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Case Management Monthly, Issue 10, October 1, 2008
When New Hanover Regional Medical Center (NHRMC) in Wilmington, NC, wanted to decrease LOS...
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Case Management Monthly, Issue 10, October 1, 2008
St. Luke’s Episcopal Hospital in Houston had several problems in its ICU: LOS rates had...
