Challenged with employing enough staff in case management departments, the need for expertise in every role, and the increased requirements from payers, case management leaders are evaluating centralizing utilization review. This centralization carries both benefits and challenges, some of which are amplified because of the current healthcare climate.
Patients often fail to tell patient access if their coverage changes, and eligibility verification software responses do not always catch it. This article discusses steps that can help prevent claims denials.
Regular meetings focus on ways to improve processes
July 7, 2016
At Saint Francis Hospital in Hartford, CT, the revenue cycle team is a strong partner of case management, reports Beth A. Greig, RN, MSN, MBA, ACM, director of case management, healthcare value, and efficiency at the 617-bed hospital.
In today’s world, it is imperative for the case management director to make sure the case management staff receives continuous training and education around payer rules and regulations, and the financial implications of what they do, says Mindy Owen, RN, CRRN, CCM, principal owner of Phoenix Healthcare Associates in Coral Springs, FL, and senior consultant for the Center for Case Management.
Errors or typos made by registrars during the collection of information or during the data entry process are “extremely prevalent” in claims denials, according to Brinn Leach-Wilson, a Merritt Island, FL-based consultant with BHM Healthcare Solutions.