Case managers need to possess a variety of skills to work effectively with patients. They need the clinical experience to perform utilization review (UR) functions, but they also need patient support and problem solving skills.
Sending out a mass mailing of a pamphlet that contained Medicare beneficiary numbers resulted in a civil monetary penalty of $6,768,000 for Triple-S Salud, Inc. (TSS), a Puerto Rican health insurance subsidiary.
Hospitals have a little more time to get a firm grasp on CMS' 2-midnight rule. CMS recently extended the probe and educate review period for the rule by six months, through September 30, 2014.
Hospitals can make better use of their electronic health record (EHR) system's audit functions not only to guard patient privacy but also to help prevent healthcare fraud, according to a new HHS Office of Inspector General (OIG) report.
