An ED patient is admitted, but then is transferred almost immediately. This kind of situation can call into question whether the admission was “good faith” or if the hospital was just trying to work around federal EMTALA requirements.
Case management is a relationship-based profession that benefits health systems, patients, colleagues, and case managers. Establishing strong relationships with representatives from the long-term care continuum, including skilled nursing facilities, rehabilitation centers, memory care units, and assisted living and independent living communities, is important for case managers.
Emergency providers can provide hospital-level acute care to patients at home under Advanced Care at Home, a new program from the Mayo Clinic that leverages technology and in-person services. The approach has been introduced in Jacksonville, FL, and Eau Claire, WI.
Work with utilization managers to understand why these denials are happening. Ensure clinical documentation is detailed enough to support inpatient level of care, and be sure to submit such evidence to the health plan while patients still are in house.
Community-acquired pneumonia is a common cause for hospital admission. This article serves to summarize new updates in the definition, prognosis, and treatment, specifically of bacterial, severe community-acquired pneumonia.
In terms of malpractice, the main question is going to be: Did the emergency department (ED) patient receive treatment as fast as he or she should have, given the relevant circumstances? EDs in known COVID-19 hotspots with long waits for intensive care unit beds probably will be treated somewhat differently than smaller community EDs, where it was mostly business as usual.
If hospitals are doing only denials management and not avoiding denials up front, they’re already behind, says Beverly Cunningham, RN, MS, consultant and partner at Oklahoma-based Case Management Concepts.