Articles Tagged With: Medicare
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Biden Administration Cracking Down on Nursing Home Safety
The Biden administration is promising an effort to improve safety and quality of care in the nation’s nursing homes. The fact sheet foreshadows substantially stiffer oversight and harsher enforcement. -
Integrating Behavioral Health and Medical Case Management
The effects of COVID-19 have brought behavioral health issues to light — and, in some cases, the handling of the pandemic has even caused behavioral health problems. With more patients presenting with mental and behavioral health issues, it is more important than ever to consider a collaborative model of care. -
Best Practices in Utilization Management
Ideally, the case manager’s utilization management role integrates discharge planning, care coordination, and resource management. It takes place on the unit where the case manager can interact directly with the care delivery team. It also is important for departments and hospitals to develop policies for utilization management procedures at the outset. -
How a Transitional Care Leader’s Organization Survived the Pandemic Chaos
In this Q&A, Hospital Case Management asked Vera Usinowicz, APN-C, supervisor of The Center for Comprehensive Heart Failure Care at The Valley Hospital in Ridgewood, NJ, to discuss how her transitional care unit kept heart failure patients out of the emergency department and hospital during the COVID-19 pandemic. -
Loneliness and Social Disconnection Common During COVID-19 Pandemic
More than one-third of Medicare beneficiaries said they were more socially disconnected, and nearly one in four reported they were lonelier during the COVID-19 pandemic, according to the results of a recent survey. -
Limited English Proficiency Can Impede the Transition Process
As the United States becomes more diverse, healthcare facilities treat more patients with limited English proficiency. This highlights the need for more effective interpreter services, especially at discharge. Care coordination and transitions could improve if health systems provide more consistent and adequate interpretation help to patients with limited English proficiency, research shows. -
Billing Records Audits Require Prompt, Thorough Responses
A government billing records audit will make most hospital leaders nervous because of the potential financial — and even criminal — consequences, but understanding the process and best practices can alleviate the stress. -
Dual-Eligible Medicare Advantage Plans Can Reduce Hospital Admissions
As U.S. healthcare providers shift to value-based care, they need to keep up with various governmental funding plans that could increase options for patients. For example, some states create opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans and Medicaid plans operated by the same insurer. Researchers suggest these plans can decrease inpatient admissions and nursing home admissions. -
Understanding Medical Necessity Improves Utilization Review Process, Reduces Denials
The case management team should be trained thoroughly on utilization review and medical necessity to avoid payer denials. The goal is to ensure patients receive medically necessary, high-quality care. -
Telemedicine Law Changes Confusing, but Waivers Protect During Pandemic
Legislation passed in December 2020 changed some telehealth requirements for mental health services. The change has prompted concern over false claims.