Case managers use a lot of lists. They use lists of nursing homes, lists of community organizations, and lists of other resources that are designed to help their patients.
But there are times when a list is not the best option, saysDiane Iverson, RN, BSN, BS, ACM, CCM, a Baltimore-area case manager. For example, when case managers are working with individuals seeking assistance for substance use disorders, lists of resources may not be effective.
Matty, an expert utilization review (UR) case manager, is shocked when she receives a letter denying payment for the entire hospital stay of Michael, who has recovered after falling severely ill with the novel coronavirus (COVID-19).
Q: If a person has a history of substance abuse, but at the time of admission appears to be of sound mind, is that patient’s personal representative still entitled to receive information about the patient’s treatment and status?
This week's instructor note dives into the recent instruction from CMS on requirements for reporting a COVID-19 diagnosis on a claim in order for the claim to be eligible for a payment increase.
This week’s Medicare updates include new guidance on elective procedures for end-stage renal disease patients during the public health emergency, new additions to the OIG work plan, updated data on opioid use in Medicare Part D, and more!
Q: As utilization review case managers, we are often tasked with assessing our hospital's risk for novel coronavirus (COVID-19) denials. What are the most important measures we should be examining?
