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.
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.
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).
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.
A lot can go wrong when an elderly patient is discharged home, from medication errors to transportation problems or self-care comprehension issues. However, an organization can create a solid discharge and transition process by focusing on some simple elements.
The good news is that the rate of 30-day readmissions is going down in hospitals across the nation, according to a CMS report. The bad news is that fines are going up. CMS also added some new conditions to its readmission prevention list for 2015.
In October 2014 a record number of hospitals were fined for excessive care transitions. In total, CMS penalized some 2,610 hospitals, and will assess fines between October 2014 and September of this year. Through these penalties, the government has given hospitals sufficient incentive to revamp their processes with an eye on preventing readmissions and improving transitions.
