Utilization management was the first role applied in acute care case management models. It was first known of as utilization review but has evolved into something much more comprehensive than that. Today it encompasses elements of resource management and denials management as well. Physicians, both the practicing physician and the physician advisor are often left out of this important process and must be included in any contemporary case management utilization management model.

Our Relias Certified CMS Professional Program will guide attendees through the entire CMS Hospital CoP manual and highlight major changes that impact hospitals. The program is divided into five parts with each part accompanied by an exam. After completing the program, attendees will receive a certification that they are a Certified CMS Professional (CCMSP).

Part III of the series will cover nursing and pharmaceutical services, including infection control, antibiotic stewardship program, and safe opioid use.

In this session, attendees will learn about the new civil rights law from Section 1557 of the Affordable Care Act as it applies to hospitals and other healthcare providers. Our expert will discuss CoPs on Section 1557 and proposed changes under the Hospital Improvement Act.

This presentation will cover the EMTALA regulations concerning On-Call Physicians. It is essential that every hospital and critical access hospital be in compliance with the federal regulations and interpretive guidelines on EMTALA and the On-Call Physician requirements. What has your hospital to educate your physicians on their on-call responsibilities? The hospital can be fined for the on-call physicians’ failure to show up when requested.

Discharge planning has become more than just the movement of the patient out of the hospital. It is a “process” that starts at the point of admission and follows beyond discharge and through the continuum of care. The Centers for Medicare and Medicaid Services have proposed more “teeth” to the process, with proposed updates to the discharge planning section of the Conditions of Participation.This program will review the most recent reimbursement challenges from the Medicare program as well as strategies for safely transitioning your patients across the continuum of care.

Our Relias Certified CMS Professional Program will guide attendees through the entire CMS Hospital CoP manual and highlight major changes that impact hospitals. The program is divided into five parts with each part accompanied by an exam. After completing the program, attendees will receive a certification that they are a Certified CMS Professional (CCMSP).

Part IV of the series will cover medical staff and board, QAPI, radiological services, laboratory services, look back program, food and dietary services, utilization review, and physical environment.