A new proposed rule aimed at reducing readmission rates and improving patient care could bring big changes for case management?in some instances requiring hospitals to nearly double the number of full-time case managers they have on staff, say experts.
If you've been working in case management, you already know that your job has gotten a lot more complicated in recent years. The tasks at hand may even be more daunting if you're a department director who is responsible for complying with a host of different mandates that continue to grow by the day.
Compliance with the 2-midnight rule can be tricky for many organizations, which has left many case managers with nagging questions about how to get it right. We got the following questions from our readers and asked two of our experts to weigh in.
As the year rolls to a close and you start to look forward to 2016, it's time to step back, look at your program, and set some goals for next year. Karen Zander, RN, MS, CMAC, FAAN, principal and co-owner of The Center for Case Management in Wellesley, Massachusetts, says it's always a good idea for case managers to stick to tried and true best practices that have been proven effective over time.
Identify the new audit process that will be used by one of the two quality improvement organizations in charge of short stays under the 2-midnight rule.
With today's emphasis on population health and better management of patients with multiple chronic conditions, payers and providers are increasingly teaming up to improve care. There's good incentive to do so. Patients with multiple chronic conditions are not only common within the Medicare population, but also use a disproportionate share of Medicare dollars.
A new notification requirement is coming next summer. Under the law, the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which was signed by President Barack Obama on August 6, any patient in observation who has been in the hospital for more than 24 hours must be clearly told?verbally and in writing?of his or her outpatient status. Hospital officials have to deliver this notification no more than 36 hours after the patient's outpatient treatments begin.
If your organization is like many others, you've probably still got some lingering questions about how to comply with the 2-midnight rule. During a recent HCPro webcast "Medical Necessity Documentation and Short Stays," Steven Greenspan, JD, LLM, vice president of regulatory affairs at Executive Health Resources in Newtown Square, Pennsylvania, and Kurt Hopfensperger, MD, JD, vice president of compliance and physician education for Executive Health Resources, tried to shed some light on areas of confusion.
After years of wavering and waffling, ICD-10 was finally set to become a reality on the first of October. The extent to which this new set of codes for medical diagnoses and inpatient hospital procedures will affect you depends largely on how your role is structured, says Stefani Daniels, RN, MSNA, CMAC, ACM, founder and managing partner of Phoenix Medical Management, Inc., in Pompano Beach, Florida.
