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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.

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Case Management Weekly

Issue 52, December 28, 2011

• Mentor Moment: Reducing readmissions

  Editor’s note: The following is an excerpt from an article that discusses strategies to...

• News: Readmission penalties likely to impact hospitals serving low income patient population

  A Kaiser Health News analysis of CMS data found that hospitals were three times more likely to have...

• Tip: Assess executive function prior to discharge

  Evaluating executive function, which relates directly to a patient’s decision-making...

Issue 51, December 21, 2011

• Sneak Peak: Cook up a solid discharge plan

  Planning a patient discharge is a lot like cooking a Thanksgiving dinner, said Karen Zander, RN...

• Mentor Moment: Mentorship program gives boost to new case managers

  New nurses just out of school often find themselves at work alongside veterans who have little...

• News: Nursing strikes loom on both coasts

  Twenty-three thousand nurses in California and 6,000 nurses in New York plan to strike by the end...

• Audio Conference: Condition Code 44: Best Practices for a Compliant Process

  “Condition Code 44: Best Practices for a Compliant Process,” a January 10 HCPro audio...

Issue 50, December 14, 2011

• Sneak Peak: Caregiver assessment guidelines

  It is sometimes difficult to determine who the caregiver of an older adult is; therefore, the first...

• Mentor Moment: Primary care physicians link social barriers to poor health

  Primary care physicians say pervasive and stubborn social barriers such as a lack of access to...

• News: Healthcare spending per person among lowest in CA

  California spends less per person on healthcare than all but eight states. New data show that...

• Audio Conference: Condition Code 44: Best Practices for a Compliant Process

  “Condition Code 44: Best Practices for a Compliant Process,” a January 10 HCPro audio...

Issue 49, December 7, 2011

• Sneak Peak: Case Study: Centralized unit facilitates patient transfers

  Patient transfers can be a case management headache, particularly for facilities that are part of a...

• Mentor Moment: Tip: Understanding the Olmstead decision

  Determining whether it’s possible to avoid nursing home placement for an elderly patient is...

• News: Study reports nursing shortage less likely than anticipated

  A new study published in the December Health Affairs indicates that the feared nursing shortage may...

• Audio Conference: Learn how patients, nurses benefit from a Just Culture

  “Learn from errors and near misses with a Just Culture,” a December 14 HCPro audio...

Issue 48, November 30, 2011

• Sneak Peak: Improving discharge procedures

  Looking to strengthen your discharge program? Karen Zander, RN, MS, CMAC, FAAN, principal and...

• Tip: Assess patient suicide risk

  Many patients who kill themselves in general hospital inpatient units don’t have a...

• News: Ability to pay appears to drive hospital length of stay

  Uninsured patients spend less time in the hospital than insured patients, according to a study...

• Audio Conference: Learn how patients, nurses benefit from a Just Culture

  “Learn from errors and near misses with a Just Culture,” a December 14 HCPro audio...

Issue 47, November 23, 2011

• Sneak Peak: Designing a space for seniors in the ED

  When his mother became a patient in an out-of-state emergency department, the experience was...

• Mentor Moment: CMS initiative aims to lower costs, improve care

  CMS recently announced a new initiative to lower costs and help physicians, hospitals, and other...

• News: Top five challenges nurses can expect to face in 2012

  A recent HealthLeaders Media article observes that healthcare changes enacted in 2010 began to...

• Audio Conference: Assess case management FTEs

  Now is the time to assess how your case management department interfaces with your...

Issue 46, November 16, 2011

• Sneak Peak: Case Study: Resource center facilitates patient transfers

  Patient transfers can be a case management headache, particularly in multihospital systems. One...

• Mentor Moment: Tip: Values of care coordination

  Care coordination emphasizes positive partnerships with nurses, physicians, and others to pace care...

• News: Hospital observation status prompts federal class action suit

  The Center for Medicare Advocacy and the National Senior Citizens Law Center allege in a class...

• Audio Conference: Assess case management FTEs

  Now is the time to assess how your case management department interfaces with the...

Issue 45, November 9, 2011

• Mentor moment: Tip: Use this checklist to prepare for discharge

  Q. Medicare beneficiaries sometimes have information about discharge planning from CMS. What...

• Sneak peek: Discharging travelers from the hospital

  Making discharge arrangements for patients leaving a facility can be challenging under the best of...

• News: Nurses urged to examine their changing role

  The three topics on everyone's mind during last week's Nursing Management Congress were...

• Audio Conference: Medicaid Final Rule for HACs

  Most healthcare professionals are unaware of CMS’ Medicaidrevisions due to healthcare...

Issue 44, November 2, 2011

• Mentor moment: Bundled payments initiative aims to lower costs, improve care coordination

  CMS recently announced a new initiative to lower costs and help physicians, hospitals, and other...

• Sneak peek: Case-finding method is workable with appropriate safeguards

  Case managers are busy, and in an era of budget cuts, they may find themselves strapped for time...

• News: Engage Nurses to Raise Patient Safety Scores

  Nurses actually touch patients, so all members of the nursing staff need to feel directly...

• Audio Conference: Medicaid Final Rule for HACs

  Most healthcare professionals are unaware of the changes in Medicaid CMS is making because of...

Issue 43, October 26, 2011

• Mentor moment: Speeding patient throughput with RTLS

  Most hospitals and busy emergency departments (ED) share certain goals—improving patient...

• Sneak peek: When case managers cover for another's assignments

  Many case managers struggle to cover their own assignments. When asked to cover the duties of...

• News: Hospitals work to lower 30-day readmission rates

  In an effort to lower readmission rates across the country, next year Medicare will institute a new...

• Audio Conference: Medicaid Final Rule for Healthcare-Acquired Conditions

  Most healthcare professionals are unaware of the changes CMS is making to Medicaid due to...

Issue 42, October 19, 2011

• Mentor moment: Redesigning the role of acute-care physicians

  ED physicians see themselves in a health reform vise, simultaneously squeezed by administrators and...

• Sneak peek: Tips for delivering discharge notices to inpatients

  Make provisions for patients with cognitive deficits or different language needs. If a patient...

• News: New problems at Dallas medical center put federal funds at risk

  Methodist Dallas Medical Center continues to face the loss of $208 in Medicare payments after a...

• News: $500 million to prevent readmissions bypasses hospitals

  What if readmissions could be prevented by agency-on-aging community organizations (CBO) that...

Issue 41, October 12, 2011

• News: Quality of care lowest among poor, minority patients

  Harvard School of Public Health (HSPH) researchers identified 178 hospitals that provide the lowest...

• Audio on-demand: Ensure proper delivery of inpatient notifications

  Without proper procedures for delivering patient notifications, hospitals can lose reimbursement...

Issue 40, October 5, 2011

• Mentor moment: Dartmouth Atlas says readmission rates show 'not much progress'

  The Dartmouth Atlas of Healthcare researchers are again pointing fingers at hospital quality of...

• Sneak peek: Case management's role in the ED

  Case managers can facilitate a shorter ED stay for patients who don't need extensive ED services...

• News: Patient Dies During Lockout in CA Nurses' Strike

  A one-day strike involving more than 23,000 nurses at 30 California hospitals has turned ugly with...

• Audio on-demand: Ensure proper delivery of inpatient notifications

  Without proper procedures for delivering patient notifications, hospitals can lose reimbursement...

Issue 39, September 28, 2011

• Mentor moment: MA becomes second state to impose fines for high readmissions; creates controversy

  Starting October 1 the Massachusetts Medicaid program, MassHealth, will fine hospitals with high...

• Sneak peek: Inpatient vs. observation services

  Determining whether a patient should be an inpatient or on observation services can be a...

• Audio on-demand: Ensure proper delivery of inpatient notifications

  Without proper procedures for delivering patient notifications, hospitals can lose reimbursement...

• News: Patient dies during lockout in CA nurses' strike

  A one-day strike involving more than 23,000 nurses at 30 California hospitals has turned ugly...

Issue 38, September 21, 2011

• Sneak peek: Understanding patients helps reduce readmissions

  MCH developed readmission questionnaires that its case managers give to patients who are...

• News: EHRs top paper in head-to-head competition

  Electronic health records (EHRs) show promise with respect to improving quality of care and...

• Mentor moment: CMS protects same-sex partners’ rights in hospitals

  CMS finalized the rules, which apply to hospitals that accept Medicare and Medicaid patients, last...

Issue 37, September 14, 2011

• Mentor moment: CMS complicates inpatient-only rule during August 23 ODF

  HCPro recently submitted questions to CMS about transmittal R2234CP, which indicates hospitals...

• 'To do' list for successful RN case managers

  Achieving success requires that RN case managers do the following:

• Sneak peek: Mandatory reporting of abusive behavior

  The National Center for Injury Prevention and Control is part of the Centers for Disease Control...

• News: 91 face charges in $295M Medicare fraud scheme

  Two nurses and 11 physicians were among 91 suspects arrested during a recent eight-city sweep and...

Issue 36, September 7, 2011

• Mentor moment: Readmission reduction program saves thousands of dollars

  A recent article in The Miami Herald describes a readmission reduction pilot program at Jackson...

• Tip: Access and liaison staff expectations

  Access and liaison personnel facilitate the entry of patients to specific levels of care and/or...

• Sneak peek: HIPAA and HITECH facts you should know

  Game changer. President Obama signed into law the $787 billion American Recovery and...

• News: Readmission rates revealed for 292 poorly performing hospitals

  A recent HospitalCompare list identifies 292 hospitals with 30-day readmission rates that are the...

Issue 35, August 31, 2011

• Mentor moment: New bundled payments initiative aims to lower costs, improve care coordination

  CMS recently announced a new initiative to lower costs and help physicians, hospitals, and other...

• News: Speeding patient throughput with RTLS

  When patients arrive at one of Christiana Care’s two EDs, they receive an RFID badge that...

• Tip: Values of care coordination

  The emphasis of care coordination is on positive partnerships with nurses, physicians, and others...

• Sneak peek: Reducing readmissions

  The first step in any hospital's readmission reduction efforts should be conducting a root cause...

Issue 34, August 24, 2011

• Mentor moment: A new perspective can help build better relationships with physicians

  I’m an old (and I do mean OLD) ICU nurse. As a working nurse, my relationships with...

• Tip: Use this checklist to prepare for discharge

  Q. Medicare beneficiaries sometimes have information about discharge planning from CMS. What...

• Sneak peek: Conducting a HIPAA review

  September has always been synonymous with students returning to the classroom. This alone might...

Issue 33, August 17, 2011

• Mentor moment: CMS proposal would eliminate homebound requirement for Medicaid beneficiaries

  A recently proposed rule (CMS 2348-P) would change the definition of homebound for the purposes of...

• News: Medicare proposes alcohol, depression screening rules

  Federal dollars would be used to screen Medicare beneficiaries for depression and alcohol misuse...

• Sneak peek: The Community-Based Care Transitions Program (CCTP)

  The Community-Based Care Transitions Program (CCTP), also known as Grant 3026, is mandated by the...

• Tip: Understanding how key concepts differ

  As healthcare becomes more complex and financial incentives become more pervasive, moving patients...

Issue 32, August 10, 2011

• Mentor moment: IPPS final rule confirms HRRP provisions

  Approximately 60 pages of the 1,500-page IPPS final rule focused on confirming the framework of the...

• News: CMS releases FY 2010 IPPS final rule

  CMS has released its final rule for the FY 2012 Inpatient Prospective Payment System integral to...

• Tip: Help physicians better understand the discharge process

  Clearing up confusion in the discharge process and obtaining administrative agreement will help...

• Sneak peek: Query patients to assess readmission reduction strategies

  Medical City Hospital (MHC) in Dallas asked its core measurement teams for acute myocardial...

Issue 31, August 3, 2011

• Mentor moment: Will readmission reduction hurt your hospital's bottom line?

  A new study suggests that hospitals will see an even bigger reduction in reimbursement if they...

• News: ACMA representatives discuss face-to-face requirement with CMS

  ACMA representatives recently met with CMS administrators in Washington, DC to present data the...

• Tip: Establish a pharmacy department contact

  ED case managers often are called upon to assist with medication access or problems related to...

• Sneak peek: Is improper billing inflating your readmission rate?

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

Issue 30, July 27, 2011

• Mentor moment: Hospitals must begin using revised ABN form November 1

  CMS has released a new advanced beneficiary notice (ABN) form that hospitals must use beginning in...

• News: CMS to focus on preventable hospitalization, dual-eligible patients

  CMS has announced new demonstration projects intended to reduce preventable hospitalizations from...

• Tip: Improve communication with postacute providers

  Communication with postacute care providers allows a smooth and optimal transition for patients and...

• Sneak peek: Is your utilization review committee functional or fictional?

  Most facilities have a UR committee, but not all organizations have a fully functional UR committee.

Issue 29, July 20, 2011

• Mentor moment: Keep case management on your patients' radar

  Consider these tips to better promote and brand case management's role and functions

• News: UCSF program reduces heart failure readmissions to 16%

  The University of California San Francisco (UCSF) Medical Center’s Heart Failure Program has...

• Tip: Use denials data

  Case managers should expect and request feedback regarding denials for any patient whose care they...

• Sneak peek: Value-based purchasing puts new emphasis on quality and patient satisfaction

  Starting October 2012, Medicare will begin paying hospitals for quality measures, according to a...

Issue 28, July 13, 2011

• Mentor moment: Patient access is the key to VBP success

  Hospitals preparing for VBP should realize that access to a strong network of post-acute providers...

• News: Revenue Cycle Institute offers helpful tools at no cost

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

• Tip: Beware of improperly submitting provider liable claims

  Don’t make the mistake of submitting a provider liable claim because a case doesn’t...

• Sneak peek: Is improper billing inflating your readmission rate?

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

Issue 27, July 6, 2011

• Mentor moment: Make use of free readmission prevention tools

  With much attention being given to preventing unnecessary readmissions, it would behoove case...

• News: Up to $500 million in funds available to help reduce HACs and readmissions

  On a recent trip to Capitol Hill, ACMA members urged legislators to revise the reporting...

• Tip: Explanations for underusing observation can raise a red flag

  Underuse of observation services creates a compliance risk.

• Sneak peek: Customized physician order streamlines face-to-face requirement, but doesn’t guarantee physician cooperation

  From the Important Message from Medicare to discharge instructions, case managers juggle a myriad...

Issue 26, June 29, 2011

• Mentor moment: CMS eyes Readmission Payment Reduction Program expansion

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

• News: Up to $500 million available to help reduce HACs and readmissions

  HHS will make up to $500 million in Partnership for Patients funding available to help hospitals...

• Tip: Know when to take charge

  Care coordination involves many levels of intervention.

• Sneak peek: Ensure proper payment for interrupted stays

  An interrupted stay occurs when a long-term acute care hospital transfers a Medicare patient to...

Issue 25, June 22, 2011

• Mentor moment: Provider-friendly change to tracking observation hours

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

• News: Patients are satisfied with discharge instructions

  Patient satisfaction scores are on the rise, according to an analysis of patient satisfaction data...

• Tip: Know when a HINN is necessary

  Providers issue notices to patients/beneficiaries so they can render them liable for certain...

• Sneak peek: Customized physician order streamlines the face-to-face requirement but doesn’t guarantee physician cooperation

  From the Important Message from Medicare to the discharge instructions, case managers juggle a...

Issue 24, June 15, 2011

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

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

• News: CMS seeks comments on vascular readmissions measure

  CMS requests public comment on a measure currently in development, “Hospital-Level 30-Day...

• Tip: Correct erroneous insurance information

  When clinicians discover new or erroneous information, a correction in the hospital billing system...

• Sneak peek: Credentials can make the difference in salary

  The most common credential among case management department employees is RN at 73%, followed by...

Issue 23, June 8, 2011

• Mentor moment: Identifying failure essential to learning from it

  I request input (100% private and confidential) from anyone who might be willing to share their...

• News: CMS releases final rule on Medicaid HCACs

  Provider-preventable conditions (PPC), including healthcare-acquired conditions (HCAC), are now...

• Tip: Partner with hospice and palliative care

  Know which agencies in your area provide hospice/palliative care. Determine where inpatient beds...

• Sneak peek: Ensure proper payment from interrupted stays

  An interrupted stay occurs when a long-term acute care hospital (LTAC) transfers a Medicare patient...

Issue 22, June 1, 2011

• Mentor moment: Senators ask for a new ACO proposed rule

  Seven U.S. senators believe the Accountable Care Organization (ACO) proposed rule will not only...

• News: HHS plans review existing rules

  On Thursday, May 26, the Department of Health and Human Services (HSS) announced its plans to...

• Tip: Align case managers with social workers

  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

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

Issue 21, May 25, 2011

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

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

• News: CDC offers tips to prepare for a zombie apocalypse

  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

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

• Sneak peek: Investigate gray areas to improve patient status assignment

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

Issue 20, May 18, 2011

• Mentor moment: MAC settles long-running inpatient billing debate

  Noridian Administrative Services LLC has put to rest the question of how hospitals should bill when...

• News: Computer program helps patients make end-of-life decisions

  Researchers at Pennsylvania State College of Medicine and Pennsylvania State University have...

• Tip: Don't overreact to PEPPER data

  The ST PERPPER distributed quarterly is helpful in identifying risk areas, such as unnecessary...

• Sneak peek: Hospital size influences case management director salaries

  Most respondents (83%) work in acute care hospitals. Others work in critical access hospitals (4...

Issue 19, May 11, 2011

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

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

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

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

• Tip: Nursing documentation requirements for observation services

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

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

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

Issue 18, May 4, 2011

• Mentor moment: Readmissions reduction program beginning to take shape

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

• News: CMS releases report on RAC improper payments

  CMS released a recovery audit contractor (RAC) update about total improper payments since the RAC...

• Tips: Evaluate medical necessity early

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

• Sneak peek: CMS answers questions about the second IM

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

Issue 17, April 27, 2011

• Mentor moment: CMS publishes IPPS proposed rule for 2012

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

• News: Community-Based Care Transitions Program topic of special ODF

  CMS will host a 90-minute open door forum May 5 for anyone who wants to learn more about its...

• Q&A: How should I display case management data?

  Q: The social workers and case managers are spending too much time collecting data, and no one...

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

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

Issue 16, April 20, 2011

• Mentor moment: Understanding semi-automated RAC reviews

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

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

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

• Share your experiences with Case Management Monthly

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

Issue 15, April 13, 2011

• Mentor moment: Improve relationships with postacute facilities

  Hospitals can begin laying the groundwork for ACOs by developing relationships with postacute...

• News: CMS releases ACO proposed rule, seeks comments

  The April 7 issue of the Federal Register includes the long-awaited proposed rule that would...

• Tip: Determine patients' resources for postacute services

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

• Sneak peek: CMS answers questions about the second IM

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

• Share your experiences with Case Management Monthly

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

Issue 14, April 6, 2011

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

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

• Sneak Peak: How to prepare your defense against a RAC audit

  by Rochelle Schiller, RN, MBA Recovery Audit Contractors (RAC) are in full force for RAC Region...

• News: More patients need home health services after hospitalization

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

• Sneak peek: When does an outpatient procedure warrant inpatient status

  It's a scenario that plays out daily at hospitals nationwide. A Medicare patient is scheduled to...

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

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

• Mentor moment: Reducing bed volume in hospitals

  One in five or six patients is now readmitted within 30 days, but penalties and incentive programs...

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

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

• Case Management Monthly is accepting submissions

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

Issue 13, March 30, 2011

• Mentor moment: ACMA meets with CMS to discuss face-to-face requirement concerns

  The ACMA public policy committee presented its concerns about the new face-to-face requirement to...

• News: CMS podcast addresses high-risk medical necessity vulnerabilities

  CMS’ Medicare Learning Network® has released the first in a series of podcasts designed...

• Tip: Patient advocacy an essential case management function

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

• Follow CMMeditor on Twitter

  You can now get all the latest case management news via Twitter.

Issue 12, March 23, 2011

• Mentor moment: Going beyond the common medical necessity thought process

  Medical necessity acquires new meaning in the context of recent MAC, RAC, and CERT denials of...

• News: Study finds link between nursing staffing and mortality rates

  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

  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

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

Issue 11, March 16, 2011

• Mentor moment: A Salute to Case Management Social Workers

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

• News: Special ODF to address inpatient quality reporting HAC measures

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

• Q&A: The QIO role in the IM process

  Q: What is the Quality Improvement Organization’s (QIO) role in the Important Message...

• Sneak peek: Tips for discharging patients with substance abuse problems

  Patients that are active substance abusers present additional challenges when it comes to planning...

Issue 10, March 9, 2011

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

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

• News: CMS increases RAC record request limit for select hospitals

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

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

  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

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

Issue 9, March 2, 2011

• Mentor moment: Medicaid RACs are coming...someday

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

• News: Obama signs new healthcare reform provision

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

• Tip: Preadmission utilization review

  Case management involvement in preadmission utilization review is essential.

• Sneak peek: Deduct active monitoring time to bill observation appropriately

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

Issue 8, February 23, 2011

• Mentor moment: Case management protocol is still debatable

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

• News: CMS announces electronic data submission tool

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

• Q&A: Backdating an inpatient admission

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

• Sneak peek: Create a compliant condition code 44 process

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

• Last chance to participate in the 2011 Case Management Monthly salary survey

  Please help us better understand your position by completing the 2011 Case Management Monthly...

Issue 7, February 16, 2011

• Mentor moment: Think of case management as a proactive team

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

• News: Alarm fatigue affects nurses, patients

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

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

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

• Sneak peek: Be assertive when communicating with physicians

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

Issue 6, February 9, 2011

• Mentor moment: CMS issues guidance on hospital inpatient admission decisions

  Medicare-certified providers, including hospitals, home health agencies and others, may soon be...

• News: Research finds pay for performance doesn't improve hypertension treatment

  Pay for performance healthcare in the United Kingdom did not decrease the incidence of negative...

• Tip: Define departmental philosophy

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

• Sneak peek: Deduct active monitoring time to bill observation appropriately

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

Issue 5, February 2, 2011

• Case management salary survey

  Please help us better understand your position by completing the 2011 Case Management Monthly...

• Mentor moment: CMS issues guidance on hospital inpatient admission decisions

  In order to clear up any confusion about inpatient admissions, CMS issued a special edition MLN...

• News: More patients scheduling ED appointments

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

• Tip: Use professional judgment when disclosing patient information

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

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

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

Issue 4, January 26, 2011

• Mentor moment: Decrease length of stay through communication and collaboration

  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

  “Acute Care Hospital Inpatient Prospective Payment System” is now available in print...

• Tip: Arrange transportation for ED patients

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

• Sneak peek: SBAR method improves communication across units

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

Issue 3, January 19, 2011

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

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

• News: 4 in 5 hospitals plan to adopt meaningful use of EHR

  Survey data released by the Office of the National Coordinator for Health Information Technology...

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

  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

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

Issue 2, January 12, 2011

• Mentor moment: Meet face-to-face requirement for home healthcare services

  Physicians must document that they or an allowed NPP has had a face-to-face encounter with the...

• News: Hospital open door forum today

  The next Hospital and Hospital Quality Open Door Forum is scheduled from 2 to 3 p.m. EST today...

• Tip: Partnering with finance department benefits case management

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

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

  Specific MS-DRGs, called transfer DRGs, can trigger certain transfer rules that cause hospitals to...

Issue 1, January 5, 2011

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

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

• News: House Republicans propose repeal of Affordable Care Act

  House Republicans have proposed a bill to repeal the Affordable Care Act and plan a floor vote...

• Tip: Use physician advisor to teach your case management team

  Physician advisors should provide regular in-service training to ensure that case managers are...

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

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

Issue 9, April 28, 2011

• News: RAC release identifies top concern per provider

  Since the inception of the permanent recovery audit contractor (RAC) program, government auditors...

Issue 8, April 20, 2011

• Tip: Case management for children with special needs

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

Issue 8, April 20, 2011

• News: HHS launches Community-Based Care Transitions Program

  The Partnership for Patients is a national partnership that aims to save 60,000 lives by stopping...