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Case Management

Case Management

Case managers and directors will find the practical tools, information, and expert analysis they need to maintain regulatory compliance and achieve the highest-quality patient care.

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Top Stories

  • Study: Longer stays equal fewer complications and readmissions

    If you want to keep patients from returning to the hospital after discharge, keep them a little longer, says a new study by Columbia Business School in New York, New York.

  • CMS nixes certification requirement for most inpatient hospital stays

    The 2-midnight rule certification headache appears to be over, thanks to the 2015 OPPS final rule, published in the November 10 Federal Register. CMS acknowledged in the final rule that the value of the certification requirement—which required organizations to document certification when a physician believes a patient qualifies for an inpatient stay—“may not outweigh the associated administrative requirements placed on hospitals.”


  • Facilities whose patients don't snooze may lose

    Looking to prevent readmissions? Your organization may want to ensure its cardiac patients are getting a good night’s sleep. A study published in the October 15 issue of the Journal of Clinical Sleep Medicine shows that cardiac patients who were successfully treated for sleep-related breathing disorders were less likely to be readmitted to the hospital within 30 days of discharge or to return to the emergency department within 48 hours.

  • Local Chapter Notices: South Carolina Chapter seeks volunteers; meeting recaps and announcements

    Two local ACDIS chapters met last week to take advantage of some ACDIS insight.

    On Wednesday, July 23, California ACDIS Chapter members joined ACDIS Education Director Cheryl Ericson, MS, RN, CCDS, CDIP, who discussed how to analyze the Program for Evaluating Payment Patterns Electronic Report (PEPPER). (Click here to take a look at her PowerPoint presentation.) The PEPPER provides an organization with insight into potential vulnerabilities that can result in denied claims and recoupment and offers CDI programs a tool to determine focus diagnoses and educational training points.

    Ericson used one CA ACDIS Chapter member’s donated (redacted) PEPPER data to show how CMS’ quarterly report illustrates potential for over and under payment for hospitals within given Medicare Administrative Contractor region, state, and national averages. She pointed out potential documentation improvement targets within stroke and pneumonia.

    "A high volume of cases with a single CC or MCC can impact mortality index and increase vulnerability to denials," Ericson says.

    On Thursday, July 24, the Michigan ACDIS Chapter met via the wonders of technology to take a virtual tour of the ACDIS website and learn more about the Certified Clinical Documentation Specialist (CCDS) credential and exam process. More than 40 people joined for the webinar, which demonstrated how to easily find helpful articles, how ACDIS polls can help CDI programs benchmark their own efforts against other programs in the nation, where to find additional salary surveys and benchmarking analysis, and other quick tips for navigating the site.

    Local chapter leaders can always call on us to pitch in for meetings. We’re happy to help as we are able. Want more information, or need to start a group in your area? Contact Associate Director Melissa Varnavas.

  • CMS finalizes two-midnight inpatient presumption as part of 2014 IPPS final rule

    CMS finalized a major change to its inpatient admission guidelines as part of the 2014 IPPS final rule, released August 1.

    As part of the rule, CMS finalized the two-midnight presumption for inpatient admissions. If a patient the physician expects a patient’s treatment, testing, or surgery to require an inpatient stay covering two midnights, and admits the patient based on that belief, CMS will presume that the stay is be medically necessary.

    CMS emphasized that the physician must formally order an inpatient admission, but added that the physician can consider the time the patient has already spent in the ED or observation when deciding whether to admit the patient.

    CMS made the change in part to reduce long outpatient or observation stays.

    CMS also finalized the timely filing requirement for Part A to Part B rebilling. In March, CMS released a ruling and a proposed rule allowing hospitals to rebill Part A inpatient services as Part B outpatient services if the inpatient stay was not medically necessary and the services would have been covered in the outpatient setting. The ruling, which went into effect in March, did not including a filing timeframe. Under the final rule, hospitals will have one year from the date of service to rebill claims.

    CMS finalized the criteria to rank hospitals with a high rate of hospital-acquired conditions (HAC). Hospitals in the lowest quartile for HACs will see a payment reduction of 1%.

    Look for more analysis of the rule from HCPro next week.

  • Mandatory flu shots aren't a deal-breaker for most medical staff

    Mandatory influenza vaccination as a condition of employment did not cause healthcare workers to flee from Loyola University Medical Center in Maywood, Ill., according to a four-year analysis of vaccination rates. With the backing of hospital leadership, infection control and prevention specialists at Loyola worked with a multidisciplinary task force to develop a facilitywide policy that made flu vaccination a condition of employment.


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