Improving the hospital experience for patients, improving the quality of care, and reducing costs were the goals when case managers at Martin's Point Healthcare in Portland, Maine, stopped working independently and started working as teams.
For many patients, home health services can mean the difference between a successful recovery and a hospital readmission, but patients who need services go without because of confusion over eligibility requirements.
Physician advisors provide a critical link between case management and physicians; it's a position that requires deft communication skills, regulatory know-how, and a stiff backbone.
Editor's note: Each year HCPro's Revenue Cycle Institute reports on the experience of providers related to the Recovery Audit Program. The article below is adapted from the 2011 Recovery Auditor Benchmarking Report, released in early 2012. The summary of last year's results is by Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro. Readers can download their complimentary copy of the full report at www.revenuecycleinstitute.com.
Case managers have already become familiar with the Medicare Recovery Audit Program. In January, however, government Recovery Auditors began focusing on new territory: Medicaid claims.
Making sure patients are prepared for discharge can be a tricky process. When certain laws are considered, getting patients to their next destination becomes even more complex.
