Compliance Measures for RN and Social Work Case Managers

Background: Case managers and social workers need to maintain compliance in a number of areas directly related to utilization management and discharge planning. Both the Joint Commission (and other regulatory bodies) as well as the Centers for Medicare and Medicaid Services (CMS) are auditing hospitals and case management departments f

Transitions in Care – A Key Role for RN Case Managers and Social Workers

Key Points: Discharge planning Transitions Conditions of Participation:  Discharge Planning Discharge planning compliance IMPACT Act Patient Choice Proactive discharge planning Multidisciplinary rounds

Best Practices in Optimizing the Skill Sets of RN and Social Work Case Managers

Description: This program will discuss the Standards of Practice for social workers and nurse case managers as defined by the Case Management Society of America as they were updated in 2016.  We will then apply those Standards to the contemporary roles of the nurse case manager and social worker.  Finally, we will apply those

The CMS Efficiency Measure: Case Management Strategies for Managing Cost and Length of Stay

Key Points: Value-Based Purchasing Efficiency Measure Length of stay Cost of Care Care coordination

Fundamental Utilization Management Practices for Value Based World

Key Points: Utilization management definition Difference between utilization review and utilization management Medical necessity defined UM processes for, and components of, medical necessity When a patient meets medical necessity When a patient does not meet medical necessity Compliance components of medical necessity

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

Interdisciplinary Care Rounds: A Key Strategy for Improving Case Management Outcomes

Key Points: Joint Commission Safety Standard 2 Vertical versus horizontal communication Crucial conversations Patient care conferences Huddles Internal patient transfers Walking rounds Walking versus bedside rounds Key members of the rounding team Key structural points Scripting Daily goals Engaging patients

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

Care Coordination: Strategies for Managing Cost and Length of Stay

Key Points: Discuss how to improve your length of stay and cost per case through better care coordination Discuss how cost across the continuum affects your hospital’s cost per case Understand where your case management department may have the biggest impact on reducing your cost and length of stay