Case Management

Sneak peek: Case management helps with the ABN process

Case Management Weekly, July 7, 2010

In most facilities, the patient access staff is in charge of the ABN process. However, most patient access staff do not have the clinical expertise to decide whether a procedure meets medical necessity.

They also feel they do not have the expertise to explain the form to patients, William Malm, ND, RN, consultant with Craneware Revenue Integrity Solutions, said during the May 10 HCPro audio conference, “ABNs and Billing for Non-Covered Services: Incorporate Recent Changes Into Policies and Procedures.”

Case management can be a solution to that problem, says Denise Majeski, BSN, RN, ACM, director of case management and social services at Northwestern Lake Forest (IL) Hospital (NLFH).

“Our facility is unique in that we placed RN case managers in the role of orders management,” Majeski says. “They check all outpatient orders received in a central location for completeness and medical necessity.”

Case managers at NLFH work in the outpatient areas of cardiac services, outpatient oncology and infusions, and the central scheduling orders management unit.

Check out the August 2010 issue of Case Management Monthly to learn more. You also can discover the benefits of becoming a Case Management Monthlysubscriber.

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