Beatrice, 66, arrives at the long-term acute care (LTAC) hospital with end-stage renal disease (ESRD), hemodialysis, malnutrition, a stage IV coccyx decubitus ulcer, depression, and no family support.
Recruiting, retention, and turnover are challenging in any profession. Case management is no exception. Experienced, competent case managers are especially hard to find, says Wendy De Vreugd, RB, BSN, PHN, FNP, senior director of case management for West Region at Kindred Healthcare, Hospital Division, in Westminster, CA.
Increased ED volumes, changes in regulatory requirements, the required use of observation, and added scrutiny from the recovery audit contractors have made implementing an ED case management model essential.
At Cabell Huntington (WV) Hospital (CHH), case managers are more than just chart reviewers, they are part of the physician team—a shift in perspective that improved the facility’s LOS and, arguably, its patient care.
Rita, an 82-year-old female, is involved in a motor vehicle accident while traveling from South Dakota to Arkansas in early January. She arrives at the hospital Sunday afternoon with a concussion and two fractured ribs.
The appeal process is much more complex than conducting a clinical review for an insurance company. Appeal writers must complete a full review of the record and consider multiple sources, such as CMS guidelines and managed care contracts, to successfully argue their case.
