Efforts to educate medical staff members on Medicare or other payer policies can be like herding cats. However, it is necessary to ensure compliance. The case management department cannot improve level of care decisions without cooperation from medical staff members.
Facilities that hold regular interdisciplinary care coordination rounds often say such meetings save time. However, the rounds can turn from time-savers to time-wasters if the matters discussed do not stay on topic or drag on.
Case managers and social workers have an active role in helping patients and families make end-of-life decisions such as using palliative care and hospice.
CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it comes to putting those rules into practice, things can get even more difficult.
As patient advocates, case managers often need to question physician decisions that do not follow evidence-based criteria or that go against patient wishes.
