Providers give Medicare beneficiaries the advance beneficiary notice (ABN) before they undergo an outpatient procedure that Medicare will likely not cover.
Preadmission Screening and Resident Review (PASRR) is a federal mandate that protects individuals with serious mental illness (SMI) or mental retardation (MR) from placement in facilities that can’t provide their specialized level of care. The screen also determines whether patients are capable of living independently.
Recruiting, retention, and turnover are challenging in any profession. Case management is no exception. Experienced, competent case managers are especially hard to find, says Wendy De Vreugd, RB, BSN, PHN, FNP, senior director of case management for West Region at Kindred Healthcare, Hospital Division, in Westminster, CA.
At Cabell Huntington (WV) Hospital (CHH), case managers are more than just chart reviewers, they are part of the physician team—a shift in perspective that improved the facility’s LOS and, arguably, its patient care.
Beatrice, 66, arrives at the long-term acute care (LTAC) hospital with end-stage renal disease (ESRD), hemodialysis, malnutrition, a stage IV coccyx decubitus ulcer, depression, and no family support.
Physicians can defer admission decisions to those who truly understand level of care—the case managers. The method is called the “admit per case management protocol.
The appeal process is much more complex than conducting a clinical review for an insurance company. Appeal writers must complete a full review of the record and consider multiple sources, such as CMS guidelines and managed care contracts, to successfully argue their case.
In March, President Obama signed the Patient Protection and Affordable Care Act into law. Although the regulations enacting the legislation remain on CMS’ to-do list, providers expect changes to how the government pays them.
