Case management directors and utilization review (UR) case managers beware! In a Frequently Asked Questions (FAQ) document released in July, CMS said it expects to discontinue enforcement discretion for Medicare fee-for-service medical reviews beginning August 3, regardless of the status of the public health emergency (PHE).
Matty, an expert utilization review (UR) case manager, is shocked when she receives a letter denying payment for the entire hospital stay of Michael, who has recovered after falling severely ill with the novel coronavirus (COVID-19).
Case managers use a lot of lists. They use lists of nursing homes, lists of community organizations, and lists of other resources that are designed to help their patients.
But there are times when a list is not the best option, saysDiane Iverson, RN, BSN, BS, ACM, CCM, a Baltimore-area case manager. For example, when case managers are working with individuals seeking assistance for substance use disorders, lists of resources may not be effective.