How is Your Hospital Paid? A Reimbursement Primer for the RN Case Manager and the Case Management Leader

Key Points: Healthcare industry today and mandate for change Prospective payment Length of stay:  What is expected and how it is impacted How we are reimbursed Healthcare reform Managed care Value-based reimbursement Bundled payments Purpose of case management in relation to reimbursement Strategies for the RN

Medicare Compliance and the Hospital RN Case Manager and Social Worker

Key Points: Compliance Rules and Regulations Conditions of Participation: Utilization Review and Discharge Planning Conditions of Participation Final Rules for Discharge Planning Traditional Medicare Medicare Advantage Case Manager Role in Compliance

Physician Relationships with Hospital Case Management: Physician Advisors and Hospitalists

Key Points: Hospital case management Best-practice case management Hospitalist Physician Advisor: Internal and External Collaboration between hospitalists and case management department Collaboration between physician advisors and case management department Dashboards to determine physician advisor and hospitalist o

Improving Care Transitions: Discharge Planning from Admission to Community Transfer

Key Points: Foundation of effective transitional planning Current rules, regulation, and standards for transitional planning Preparing for a CMS survey with the Conditions of Participation for discharge planning Barriers to effective discharge planning Case Management department strategies for effective discharge planning

Fundamental in Hospital Case Management: A Boot Camp Series

Overview The rapidly changing healthcare world is altering the role of case management in terms of value-based reimbursement, the Affordable Care Act, the continuum of care, bundled payments, transitions in care, or accountable care organizations, case management. This jam-packed five-part series will be the answer to all your queries

Case Management Outcomes Measurement for Effective Practice

Key Points: Case management outcomes definition Quality, financial and productivity outcomes affected by a case management department Each set of outcomes, how they are measured and how to select benchmarks for them How to integrate these outcomes into a useful case management report card How to report case management outcom

Best Practice Utilization Management: 10 Tips for Success

Key Points: Business of case management Difference between utilization review and utilization management Compliance of utilization management Access points for utilization management Types of utilization management Denial management Incorporating utilization management into case management rules and functions Physician

Acute Care Case Management: Roles, Functions, Models and Staffing Ratios

Key Points: Why change your structure now Model of care definition Contemporary case management roles Comparison of two models Integrated model Access point case management in the integrated model Collaborative / Triad Model Departmental structure Staffing ratios in both models Key differences between models Simi

Priming Acute Care Reimbursement: From DRGs to Bundled Payments

Key Points:     Diagnosis-related groups (DRG)     Medicare     Medicaid     Managed care definition     Managed care contracting     Case rate, per diem and % of charges contracts     Managed