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


Rules and regulations for hospital case management departments have been expanding and changing, especially over the past decade.  Compliance regulations for Medicare patients are more complex and impact the way the case management staff operationalize their roles.  In the past, there was little focus on the case management department regarding compliant case management practice—but that was then…….and this is now!  Over time there have been both added regulations and added oversight by governmental 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 to care, to the very recent final rules for the discharge planning section of the Conditions of Participation—it’s our responsibility to maintain compliance in case management. 
This webinar will review the compliance regulations affecting your Medicare patients—both traditional Medicare and Medicare Advantage beneficiaries.  Never has this been more important than it is now.

Session Outline:
  • Compliance:  What it is and who it affects
  • Compliance: It’s impact on the hospital and on patients
  • Compliance at your access points
  • Compliance regulations
  • Observation
  • CMS Conditions of Participation:  UR and discharge planning
  • Final rule changes to discharge planning Conditions of Participation
  • MOON
  • 2-midnight rule
  • NOTICE Act
  • Compliance and the physician:  Attendings, consultants and physician advisors
  • Case management compliance strategies
  • Sample compliance gap analysis
Learning Objectives:
  • Discuss the elements of compliance that affect the daily practice of a case manager in working with Medicare patients
  • Review the CMS requirements and how you can be compliant with them
  • Introduce the Conditions of Participation final rules for discharge planning
  • Identify compliance gaps in your daily practice
  • Understand each compliance point and why it is important in the case manager’s practice
Why You Should Attend?

As case management professionals, we work with rules and regulations that require compliance. Therefore, we must be up to date on each and every compliance requirement.  Hot off the press is the recent Conditions of Participation final rule for discharge planning.  The new rules will be discussed, as will suggestions for successful implementation.  
As we collaborate with physicians and other healthcare team members, we must assist them in understanding these rules and regulations.  Physician advisors must also understand these in their interactions with physician providers.  But, it’s not only compliance knowledge, it’s actually operationalizing it. This webinar will bring you up to speed on what you need to know to be successful in your compliance role as an RN case manager or social work case manager. It will help you identify where you may have compliance practice gaps, as well as how to fix them.

Who Should Attend?
  • Director of Case Management
  • RN Case Managers
  • Director of Compliance
  • Director of Social Work
  • Social Worker Case Managers
  • Physician Advisors
  • Compliance Directors
  • Executive Responsible for Case Management


Recorded $ 213.00
Transcript $ 213.00
DVD $ 223.00
Recorded + Transcript $ 323.00
DVD + Recorded $ 333.00
DVD + Transcript $ 333.00
Total $ 0.00

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