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

Beverly Cunningham

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

Healthcare
Jan 15, 2020
60 Minutes
Recorded Webinar

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 case manager, social work case manager and case management leader
Understanding reimbursement, its relationship to case management and case management’s relationship to it
Collaboration with patients, families and caregivers in relationship to reimbursement

Description:

Rules and regulations for hospital case management departments have been growing and changing, especially over the past decade. Compliance regulations for Medicare patients are increasing and are impacting the way the case management staff operationalize their roles. In the past there was not a focus on the responsibility to have a compliant case management practice—but, that was then…….and this is now!! Over time there have been both additional regulations and additional oversight by regulatory bodies to ensure compliance. With this increased oversight and the number of increased regulations (more every year) both RN case managers and social work case managers must be compliant with any of these regulations that affect their patients. From the CMS Conditions of Participation to such rules as the 2-midnight rule, the MOON, the NOTICE Act, medical necessity and levels of care--it’s our responsibility to maintain compliance in case management.

This webinar will review the compliance regulations affecting your Medicare patients—for both traditional Medicare and Medicare Advantage plans. Never has this been more important than it is now.

Session Highlights:

Understand the various reimbursement systems for hospitals.
Integrate reimbursement knowledge, including your patient’s financial responsibility into your case management care coordination plan.
Review alternative payment models and understand the role of the RN case manager and/or social work case manager in these new models.

Why Should You Attend?

This webinar will focus on a basic understanding of reimbursement—from the government, from the state, and from commercial payers. The process of payment for value will also be reviewed.

The staff RN case manager and social work case manager must understand the structure for their hospital’s reimbursement, as well as any patient responsibility for the hospital stay, such as Medicare acute care patient days.

The transition from payment for volume to payment for quality and bundled payment programs requires the case management staff and leaders to understand the concepts presented in this webinar.