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Case Management Weekly

Case Management Weekly is a free e-mail newsletter that offers news, resources, and Q&As to help case managers from all settings find ways to enhance quality and reduce legal and compliance risks.

2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004

Case Management Weekly

Issue 52, December 29, 2010

• Mentor moment: A dozen ways to prevent readmissions

  The new year is almost here, and many hospitals are resolving to reduce preventable readmissions.

• News: TMF announces PEPPER updates

  TMF Health Quality Institute, the agency that provides Program for Evaluating Payment Patterns...

• Q&A: Referring patients to postacute care providers with which hospitals have a financial relationship

  Q: Should hospitals refer patients to postacute care providers with which they have a financial...

• Sneak peek: Work with bed flow coordinators to improve throughput

  Although the bed flow coordination is often incorporated into the case management director role...

Issue 51, December 22, 2010

• Editor’s note: Happy holidays from HCPro, Inc.

  On behalf of HCPro, Inc., and the members of the Case Management Monthly Advisory Board, I would...

• Mentor moment: Communicate with coders to assign proper discharge codes

  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

  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

  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

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

Issue 50, December 15, 2010

• Mentor moment: Revenue Cycle Institute releases 2010 RAC Preparedness Benchmark Report

  The results of HCPro’s second annual “RAC Preparedness Benchmarking Report” are...

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

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

• Q&A: Counting observation hours

  Q. If an observation patient stays more than 24 hours, and possibly up to 40 hours, may you bill...

• Sneak peek: Clinical protocols improve throughput at children’s hospital

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

Issue 49, December 8, 2010

• Mentor moment: A 24-hour stay does not equal observation

  After years of discussion and attention given to observation services and inpatient status, there...

• News: Number of children and adolescents with eating disorders on the rise

  Increasingly more children and adolescents have been diagnosed with eating disorders, according to...

• Tip: Reviewing medical necessity of inpatient denials

  A two-step approach may be helpful when reviewing the medical necessity of an inpatient denial.

• Sneak peek: Patient choice is about quality, not quantity

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

Issue 48, December 1, 2010

• Mentor moment: Medical necessity takes on new meaning

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

• News: CMS requests comments on ACO program

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

• Tip: Use FISS to track Medicare benefit days

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

• Sneak peek: Effective physician advisors enhance documentation

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

Issue 47, November 24, 2010

• Mentor moment: CMS revises Important Message from Medicare

  Beginning in April 2011, hospitals must have patients or representatives include the time that they...

• News: Number of ED visits continues to rise

  The annual number of ED visits increased by 23% between 1997 and 2007, according to a study...

• Tip: Dual-eligible beneficiaries

  Dual-eligible beneficiaries are individuals who qualify for both Medicare and Medicaid coverage.

• Sneak peek: Perform a forced discharge if a patient refuses to leave

  Care providers accept the general principle that patients have the right to direct their own care...

Issue 46, November 17, 2010

• Mentor moment: RAC talk with Kimberly Anderwood Hoy

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

• News: Muslim women willing to delay care for preferred physician

  Muslim American women are willing to delay care if they can’t find a physician that's of the...

• Tip: Prepare nursing home staff for difficult patients

  At times, nursing home patients are sent to the ED and, when medically worked up and cleared for...

• Sneak peek: Handling IV drug users who need IV treatment

  Several facilities share their strategies for caring for IV drug users that require IV antibiotic...

Issue 45, November 10, 2010

• Mentor moment: CMS takes first step toward Medicaid RAC implementation

  CMS released the long-anticipated proposed rule for Medicaid recovery audit contractors (RACs...

• News: One in ten hospital admissions is preventable

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

Issue 44, November 3, 2010

• Mentor moment: The ED case manager plays a key role regardless of patient status

  Every hospital should have a case management presence in the emergency department.

• News: Bill will allow observation time to count toward three-day SNF requirement

  Joe Courtney (D-CT) has introduced a bill (HR 5950) in the House of Representatives that will allow...

• Tip: The personal health record

  The goal for using the patient-centered record, or the personal health record, is that the patient...

• Sneak peek: Persistence pays off with difficult psychiatric patient

  Sarah arrives at a large medical center after a failed suicide attempt in which she ingested...

Issue 43, October 27, 2010

• Mentor moment: Hospital leaders consider case management a top priority

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

• News: Studies say pneumonia is misdiagnosed on readmission

  Nearly three in four patients were misdiagnosed with pneumonia when they were readmitted to the...

• Tip: Offering patients one postacute choice

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

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

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

• Sneak peek: Top 10 hospital case manager best practices

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

• Sneak peek: Strengthen postacute relationships to prepare for healthcare reform

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

Issue 42, October 20, 2010

• Mentor moment: Offer physicians insight, not just 'education'

  The detail of clinical documentation assumes a new role for surgeons as we move towards bundled...

• News: Studies say depression, weight, race, and Medicaid status contribute to readmissions

  The Journal of Hospital Medicine published two articles that show a relationship between race...

• Tip: Policies, procedures, and state privacy rules

  All discharge planners should be aware of their own hospital policies regarding consent and their...

• Sneak peek: BOOST patient satisfaction and reduce readmissions

  Project BOOST is gaining popularity among providers nationwide as a method to reduce...

Issue 41, October 13, 2010

• Mentor moment: Happy Case Management Week

  National Case Management Week is your opportunity to tell everyone else what you and your fellow...

• News: HHS announces $727 million in grants for community health centers

  The Department of Health and Human Services (HHS) will award $727 million in construction and...

• Tip: Review one-day stays for medical necessity

  One-day stays are common problem areas that are easy for RACs to target. Make sure your UR...

• Sneak peek: Should CMS eliminate observation services?

  Some providers think CMS can eliminate extended observation stays by eliminating observation...

Issue 40, October 6, 2010

• Mentor moment: Medicaid RACs coming soon

  CMS has begun laying the groundwork for expanding the RAC program to Medicaid. The agency released...

• News: OIG Work Plan shows a new focus on medical devices and radiation therapy

  Medical devices, radiation therapy quality and safety, and an expanded focus on the three- and...

• Q&A: What do case managers contribute to a hospital's RAC team?

  Case management or UR nurses are vital to the RAC team, not only for risk assessment and minimizing...

• Sneak peek: Three in 10 case managers say workload is unmanageable

  Sixty-four percent of respondents to a recent HCPro survey said they have a lot to do, but feel it...

Issue 39, September 29, 2010

• Mentor moment: Improve communication between physicians and case managers to prepare for reform

  Case managers and physicians will need to improve relationships to meet healthcare reform...

• News: CMS publishes RAC improper payment vulnerabilities

  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?

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

• Sneak peek: Helping noncompliant patients cheat more effectively

  Teaching noncompliant patients how to cheat seems counterproductive, but this strategy saved lives...

Issue 38, September 22, 2010

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

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

• News: Sebelius warns insurers against unjustified rate hikes

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

• Q&A: What is case management's role in quality improvement?

  Q. What is case management’s role in quality improvement?

• Sneak peek: Leaving against medical advice

  Working with a patient who is leaving against medical advice (LAMA) can be difficult. Although the...

Issue 37, September 15, 2010

• Mentor moment: Position your resources to prepare for RAC medical necessity audits

  The recovery audit contractors (RAC) have certainly been busy lately. CMS gave permission to three...

• News: Drug resistant bacteria arrives in U.S.

  Physicians and scientists have discovered bacteria that contain a new gene making them resistant to...

• Sneak peek: Dispute inappropriately denied readmissions

  Several case managers recently have received readmission denial letters from their regions&rsquo...

Issue 36, September 8, 2010

• Mentor moment: Providers ask CMS to abolish observation services

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

• News: Shortage of medical imaging isotopes could threaten quality of care

  A worldwide shortage of medical imaging isotopes may jeopardize patient care, according to...

• Tip: Assess each patient's readmission risk

  The first stage of a complete approach to managing hospital readmissions is assessment of each...

• Sneak peek: Private care managers advocate for patients after discharge

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

Issue 35, September 1, 2010

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

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

• News: CDC study shows high cost of motor vehicle injuries

  The cost of medical care and productivity losses associated with motor vehicle injuries exceeded...

• Tip: Create a discharge planning evaluation and assessment checklist

  A discharge planning evaluation and assessment checklist guides discharge planners in identifying...

• Sneak peek: Take UR out of case management

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

Issue 34, August 25, 2010

• Mentor moment: Tailor discharge instructions to your patients' needs

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

• News: California launches nations' largest telehealth network

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

• Q&A: Specific post-acute orders

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

• Sneak peek: Measure department effectiveness beyond LOS

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

Issue 33, August 18, 2010

• Mentor moment: Address fragmented care to prevent readmission denials

  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

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

• Tip: Working with patients who have low health literacy

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

• Sneak peek: ’Ticket to Home’ tool helps patients and families prepare for discharge

  Children’s Healthcare of Atlanta (CHOA) staff realized they needed to improve the...

Issue 32, August 11, 2010

• Mentor moment: Inpatient admissions decision fuels RAC uncertainty

  Recent approval of a RAC issue for inpatient hospital claims review has initiated uncertainty...

• News: Study says 1 in 5 Americans skipped medical care in 2010

  One in five Americans who became ill or suffered an injury during 2010 did not seek medical care...

• Tip: Identify the caregiver

  Caregivers coordinate the process of accessing care from a multitude of providers, ensuring needed...

• Sneak peek: Care coalition chips away at transition problems

  Transitioning patients to the next level of care is sometimes a chore.

Issue 31, August 4, 2010

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

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

• News: Study says hospitalists are unaware of hospital costs

  When most hospitalists write an order for a chest x-ray, they have no idea how much the test costs...

• Tip: Schedule regular staff meetings

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

• Sneak peek: Protect patient information when communicating with payers

  A fundamental tenet of the HIPAA Privacy Rule requires hospitals and other covered entities that...

Issue 30, July 28, 2010

• Mentor moment: Don't let medical necessity documentation get away

  During a recent consulting project, I had an opportunity to observe a facility’s transition...

• News: Higher readmission rate possible consequence of successful care

  Despite economic challenges, patient satisfaction with U.S. emergency departments (ED) remained...

• Tip: Assigning ICD-9-CM codes a multistep process

  The ICD-9-CM coding system requires extensive training and experience. However, the general process...

• Sneak peek: Anticipate and avoid PASRR delays

  Preadmission Screening and Resident Review (PASRR) is a federal mandate that protects individuals...

Issue 29, July 21, 2010

• Mentor moment: CMS identifies common vulnerabilities, hints at medical necessity reviews

  CMS recently released a special edition MLN Matters article that provides information about...

• News: Higher readmission rate possible consequence of successful care

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

• Tip: Steps in the discharge planning process

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

• Sneak peek: Team-based case management improves navigation

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

Issue 28, July 14, 2010

• Mentor moment: Case management involvement in implementing healthcare reform

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

• News: Readmission data added to hospital compare site

  The Centers for Medicare & Medicaid Services (CMS) updated information related to 30-day...

• Q&A: Discharge plan for outpatients

  Q: Sometimes I receive calls from physicians’ offices to help create a discharge plan for a...

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

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

Issue 27, July 7, 2010

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

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

• News: Study says US healthcare system trails other developed nations

  The United States ranked last and the Netherlands ranked first among seven nations in a healthcare...

• Tip: Understanding reimbursement facilitates utilization management

  Understanding how hospitals receive payment for the care provided to patients helps case managers...

• Sneak peek: Case management helps with the ABN process

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

Issue 26, June 30, 2010

• Mentor moment: What the EHR means to case managers

  Case managers should be involved in all process improvement initiatives as payers move toward...

• News: Study says follow-up appointments don't prevent readmissions

  A recent study by Mayo Clinic researchers found that patients discharged from a hospital with...

• Tip: When to start and stop the observation clock

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

• Sneak peek: Hospitals team up to tackle frequent ED visitors

  Unlike politicians who only give lip service to working with rivals, two Lincoln, NE hospitals...

Issue 25, June 23, 2010

• Mentor moment: Case managers descend on Capitol Hill

  Members of the American Case Management Association (ACMA) returned to Washington DC last week to...

• News: New Jersey hospitals team up to reduce heart failure readmissions

  The New Jersey Hospital Association’s Institute for Quality and Patient Safety recently...

• Tip: Understand and rely on essential case management model components

  Case management models have at least seven fundamental components, regardless of the type of...

• Sneak peek: Tips for crafting a successful appeal letter

  Navigating the appeals process requires knowledge and skill.

Issue 24, June 16, 2010

• Mentor moment: A holistic approach to ED case management

  The ED is a major source of inpatient admissions and serves as the fundamental base for...

• News: Study says many critically ill patients don't arrive at ED in ambulance

  Nearly half of critically ill patients (47%) and 15% of emergency department (ED) patients overall...

• Tip: Address caregivers' comfort

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

• Sneak peek: Position your department for payment reform

  The shift to global payments means hospital case managers will be more involved in patient care...

Issue 23, June 9, 2010

• Prevent unnecessary readmissions: Combine revenue cycle, utilization review, quality efforts

  One in five Medicare patients is rehospitalized within 30 days, costing the nation more than $17...

• Mentor moment: Conduct cost benefit analysis to improve care

  Case managers can compare costs at different levels of care to help determine which level is...

• News: Many top hospitals restrict visitation, surrogate decision-maker rights for gay and lesbian patients

  Nearly half of the nation's largest hospitals (42%) don’t have policies allowing unrelated...

• Tip: The ED case manager's role in quality improvement

  ED case managers have a unique position in the hospital. They can provide quality oversight of...

• Sneak peek: Counting inpatient hours while using case management protocol

  Case management professionals continue to debate how to bill for the time that a patient is in the...

Issue 22, June 2, 2010

• Prevent unnecessary readmissions: Combine revenue cycle, utilization review and quality efforts

  During this 90-minute audio conference our speaker will discuss government regulations and guidance...

• Mentor moment: Resources to help keep up with healthcare reform regulations

  HHS and other government agencies will follow healthcare reform legislation with much rulemaking...

• News: Study says 40 percent of inpatients return to hospital within 2 years

  A new study conducted by the Agency for Healthcare Research and Quality (AHRQ) found that two out...

• Q&A: Physician referral to a specific post-acute provider

  Q: Should a physician write an order for a specific post-acute provider, such as a home health...

• Sneak peek: Denial prevention via records and contract language

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

Issue 21, May 26, 2010

• Mentor moment: Improve PASRR processes to prepare for healthcare reform

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

• News: Healthcare reform could extend coverage to 13.7 million more young adults

  A new study from The Commonwealth Fund estimates that healthcare reform will extend coverage...

• Tip: Use physician advisors to improve communication

  Stepping in when admitting physicians don’t concur with patients’ level of care as...

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

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

• Case Management Boot Camp survey part two

  We are continuing to explore the possibility of offering a Case Management Boot...

Issue 20, May 19, 2010

• Mentor moment: Taking on RACs requires teamwork

  For the past two years, Jennie Edmundson Hospital has been planning and preparing for the RAC...

• News: Study says one in three CA patients are readmitted within a year

  More than a third of the 1.7 million individuals admitted to California hospitals in 2005 were...

• Tip: Assess patients' medical necessity for continued stay

  During a hospital stay, case managers should evaluate patients for continued medical necessity.

• Sneak peek: What does case-mix index mean to you?

  Case management departments can use CMI like a barometer of change within an organization

Issue 19, May 12, 2010

• Mentor moment: Helping noncompliant patients cheat more effectively

  Teaching noncompliant patients how to cheat seems counterproductive, but this strategy saved the...

• News: CMS says medical necessity audits will begin 'within a month'

  CMS representatives addressed two developing RAC areas during the May 5 RAC 101 conference call for...

• Tip: Keep up-to-date with regulatory changes

  Case managers should be active participants with respect to matters that affect patient care. Stay...

• Sneak peek: Patients deserve a choice in the discharge plan

  To get a better idea of how hospitals comply with requirements associated with the second IM, the...

Issue 18, May 5, 2010

• Mentor moment: Using Condition Code 44 when physicians don't agree

  Condition code 44 is a gift from CMS. Providers use it weekends, late at night, and other times...

• News: HIPAA violator sentenced to prison

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

• Tip: Meet patient demand and manage capacity

  Considering vacant areas of a hospital during periods of overcrowding is an effective demand and...

• Sneak peek: Patients deserve a choice in the discharge plan

  Hospitals have options when it comes to documenting that the patient was given a choice of...

Issue 17, April 28, 2010

• Mentor moment: Do case managers communicate effectively?

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

• News: iPad facilitates patient education

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

• Q&A: Changing hospital culture

  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

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

Issue 16, April 21, 2010

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

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

• News: President Obama calls for changes to restrictions on hospital visitors and surrogate decision makers

  President Barack Obama has directed the Secretary of Health and Human Services to expand...

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

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

• Sneak peek: Communication with CDI professionals can help meet common goals

  More and more clinical documentation improvement (CDI) programs have popped up in hospitals across...

Issue 15, April 14, 2010

• Mentor moment: OIG report highlights need for HAC/POA review

  In light of the Office of Inspector General (OIG) report Adverse Events in Hospitals: Methods for...

• News: Healthcare reform package expands RAC program to Medicaid

  The Patient Protection & Affordable Care Act approved last month, requires federal government...

• Tip: Track data to prevent denials

  Denials, like most issues in healthcare, should be tracked and trended over time to determine the...

• Sneak peek: Identify your department’s revenue cycle risk; ensure adequate staffing

  Case management departments now perform several additional functions (e.g., managing core measures...

Issue 14, April 7, 2010

• Mentor moment: Visit us at the 2010 NICM/ACMA National Conference

  If you plan to attend the 2010 NICM/ACMA National Conference April 8–11 in San Antonio...

• News: GAO says CMS must do more to prevent improper payments

  More than five years after the Recovery Audit Contractor (RAC) demonstration program began, CMS...

• Tip: Keep case management notes short and sweet

  Case managers should document the medical record each and every time a case management intervention...

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

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

Issue 13, March 31, 2010

• Mentor moment: RACs continue to add DRGs to target lists

  Mentor moment: RACs continue to add DRGs to target lists

• News: Obama will name Berwick as new CMS administrator

  News: Obama will name Berwick as new CMS administrator

• Tip: UR committee members should possess different skills, perspectives

  Tip: UR committee members should possess different skills, perspectives

• Sneak peek: Interpreters help overcome linguistic and cultural barriers

  Sneak peek: Interpreters help overcome linguistic and cultural barriers

Issue 12, March 24, 2010

• Mentor moment: Proactive discharge planning

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

• News: President Obama signs healthcare reform bill

  President Barack Obama signed the Affordable Health Care for America Act into law Tuesday morning.

• Q&A: Providing post-acute choices to Medicare Advantage members

  Q: Hospitals tell staff to provide all available post-acute choices to Medicare Advantage members...

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

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

Issue 11, March 17, 2010

• Mentor moment: ACMA takes second Important Message from Medicare concerns to CMS

  American Case Management Association (ACMA) CEO Greg Cunningham met with CMS officials recently to...

• News: Patients have more control over end of life with new document

  Minnesota’s largest healthcare organizations are working toward adopting a new medical...

• Tip: Advise patients about their post-acute facility choices

  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

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

• Quick Poll: Audio conference topics

  Which of the following audio conference topics would you most interested in?

Issue 10, March 10, 2010

• Case Management Boot Camp survey

  We are currently exploring the possibility of offering a Case Management Boot Camp—intensive...

• Mentor moment: Medical necessity - It's a physician thing

  Medical necessity for inpatient hospitalizations—or lack thereof—is a contentious topic...

• News: President sets new healthcare reform deadline

  President Barack Obama sent his latest reform proposal to Congress last week and said he would like...

• Q&A: Documenting patients’ post-acute choices

  Q: Is documenting post-acute care choices given to patients sufficient or is a signature...

• Sneak peek: RAC medical necessity audits are coming - are you ready to appeal?

  The recovery audit contractors (RAC) are up and running. CMS is approving new audit topics all the...

Issue 9, March 3, 2010

• Mentor moment: AHA affiliate publishes a readmissions guide

  To help hospitals curb the number of preventable readmissions, the Health Research &...

• News: House approves elimination of health insurers’ anti-trust exemption

  The U.S. House of Representatives voted 406–19 in favor of eliminating the antitrust...

• Q&A: How to evaluate a discharge planning process

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

• Sneak peek: How can discharge planning prevent readmissions?

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

Issue 8, February 24, 2010

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

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

• News: OIG report examines RAC fraud referrals

  Recovery Audit Contractors (RACs) referred only two cases of potential fraud to CMS during the RAC...

• Tip: Discharge planners ’worksheet’

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

• Sneak peek: Interstate transfers create financial, logistical challenges

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

Issue 7, February 17, 2010

• Mentor moment: A nurse is more than just a nurse

  Kimberly Richert, RN, CCDS looks back on her 20 year nursing career.

• 2009 Case Management Monthly salary survey

  We want to provide you with the salary information for case managers that you need in the most...

• News: Physicians say linguistic and cultural barriers negatively affect patient care

  Nearly half of U.S. physicians say language and cultural barriers are at least minor obstacles to...

• Tip: Compliant reduction of one-day stays

  Your facility may be noncompliant with Medicare guidelines if it instructs staff members to do any...

• Sneak peek: Ten steps to implementing ED case management

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

Issue 6, February 10, 2010

• Mentor moment: Understanding CERT helps address clinical documentation deficiencies

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

• News: CMS confirms HCPro's condition code 44 guidance

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

• Tool: Dealing with government auditors chart

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

• Sneak peek: ACE demonstration improves care coordination and lowers costs

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

• 2009 Case Management Monthly salary survey

  We want to provide you with the salary information for case managers that you need in the most...

Issue 5, February 3, 2010

• 2009 Case Management Monthly salary survey

  We want to provide you with the salary information for case managers that you need in the most...

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

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

• News: Joint Commission reports patient care improved in 2009

  In the past seven years, U.S. hospitals have steadily improved the quality of patient care...

• Tip: Factors to consider before admitting a patient

  Consider the following when deciding whether to admit a patient:

• Sneak peek: Daily flash rounds improve interdepartment communication

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

Issue 4, January 27, 2010

• Mentor moment: Meeting meaningful use criteria

  If you are fortunate enough to work in a setting that uses case management software and/or EHRs...

• News: CBO says Senate healthcare reform bill would extend life of Medicare Part A payments

  If Congress passes the Senate’s version of the healthcare reform bill, the life of...

• Tip: Documenting discharge planning

  Using documentation in the medical record to support discharge decisions is important when...

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

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

Issue 3, January 20, 2010

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

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

• CMW news: Survey says recession causing medication errors

  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

  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

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

Issue 2, January 13, 2010

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

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

• CMW news: CMS' actuary weighs health reform

  A memo written by Richard Foster, CMS’ chief actuary, says that the Senate healthcare reform...

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

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

• CMW Tip: Interpreting for LEP patients

  Regardless of how hospitals provide language assistance, providers of those services should possess...

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

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

Issue 1, January 6, 2010

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

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

• CMW tip: Consider multiple physician advisors

  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

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

Issue 37, September 15, 2010

• Q&A: What information should discharge planners document in the medical record

  Q. What information should discharge planners document in the medical record?