Historically, the healthcare revenue cycle has been dominated by fee-for-service (FFS) payment arrangements that reimburse providers for the volume of care they provide. These reimbursement models have always been tempered by medical necessity determinations to ensure that the care delivered to patients is in fact medically necessary. Over the past several decades, healthcare costs have been rising precipitously. In response, new payment models have been developed to curb that trend and to deliver more cost-effective care with higher quality and better outcomes.
If your department is looking for a new case manager, the stakes can be high. Hiring the wrong person can result in lost time, money, and productivity. Find the right fit the first time by following some simple strategies that help you move past the candidate's paper persona and get a better picture of how he or she will perform in a real-life setting.
This January, CMS expanded its readmissions prevention program, adding two more procedures to its list of conditions for which hospitals can be penalized if patients with the conditions are readmitted to the hospital within 30 days of discharge. To prevent these readmissions, hospitals and case managers need to understand the factors that drive them.
Many of the facilities that once specialized in mental health services across the country have shut their doors in recent years, making it more likely than ever that hospitals will encounter patients with mental health needs in the emergency department (ED).
The Office for Civil Rights (OCR) announced December 8, 2014, that it fined an Alaska behavioral health service $150,000 for potential HIPAA violations. OCR entered into a resolution agreement with Anchorage Community Mental Health Services (ACMHS), a nonprofit behavioral healthcare service, per the announcement (see www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/acmhs/amchs-capsettle...).
