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.
The case manager must examine every component of the discharge process for opportunities for improvement; one aspect that deserves increased investigation is the handoff of the patient from the hospital to another care provider.
