Memorial Hermann Healthcare System (MHHS) in Houston includes nine acute care hospitals, one children's hospital, three long-term acute care hospitals, three specialty care hospitals, 21 regional affiliates, a home health agency, a retirement/nursing center, 10 ambulatory surgery centers, 21 imaging centers—and only one HIM department.
Prior to July 1, 2008, however, that was not the case. MHHS' medical records/HIM departments used to be facility- based. Each hospital had its own medical records department, its own coders, and its own vendors. But MHHS' leadership recognized that in an era when cost savings are a must, this model was not as efficient as it could be. A restructuring of the department was in order.
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.
