At many hospitals the terms Utilization Management (UM) and Utilization Review (UR) are used interchangeably. Are they the same thing? No, they're not, according to Stefani Daniels, RN, MSNA, ACM, CMAC, and Ronald L. Hirsch, MD, FACP, CHCQM.
Case management in Alaska isn't for the faint of heart, according to Randi Ferrare, RN, BSN, interim director of case management and social work at Providence Alaska Medical Center. Some of the challenges force case managers at Providence Alaska to work a little harder and get a little more creative to meet the needs of its patient population. One innovative program at the hospital is its case management educator position.
More and more hospitals are choosing to become part of Accountable Care Organizations (ACO) in an effort to streamline patient care and reduce costs. If your organization is considering joining an ACO, you may have questions about how these groups work and how the change might affect your job. CMM asked several experts for the lowdown on what the transition to an ACO might mean for case managers.
Many hospitals have added case managers to their EDs, but these case managers face unique situations. CMM experts answer questions about how to handle these issues.
Whether it's a precautionary CT scan that may not really be needed or a duplicate laboratory test ordered by separate physicians, many hospitalized patients are getting unnecessary tests, and experts say it's a big problem.
EDs have a lot to handle. One in every three Americans will visit an ED each year, and among those are a number of populations that bring special challenges.
In November 2014, CMS put its certification requirement under the 2-midnight rule to bed, finally conceding that the rule was creating more problems than it solved. While many frustrated case managers celebrated this development, they still aren't completely off the hook. CMS replaced the global certification requirement with two more-specific certification requirements that went into place on January 1, and case managers need to be aware of them.
Condition codes can cause considerable confusion for case managers. Coders use them to support payment for out-of-the-ordinary situations?for example, an inpatient being changed to outpatient status.
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.
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).
