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.
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.
