Untreated mental conditions can prevent patients from properly managing physical health, thus causing the patient to be readmitted to the hospital, which is why case managers should coordinate mental and physical treatments.
Experts expect the RACs to begin auditing medical necessity this summer. Case managers may be asked to play a large role in appealing medical necessity denials because of their involvement in level-of-care determinations. To help case managers, we asked Medicare appeals experts to explain the case manager’s role in the appeals process.
Considering communication is at the heart of what all case managers do, case management leaders should think about making solving the problem of language and cultural barriers a top priority.
At this juncture in the evolution of case management services, we have reached the tipping point of hospitals acknowledging that they should have some evaluation of each patient’s level-of-care needs at the front door.
When executing an interstate transfer, case managers must account for different Medicaid programs and payers, high transportation costs, and unfamiliar physicians—not to mention the challenge of finding an accepting facility.
