Hospital Case Management – February 1, 2012
February 1, 2012
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Prepayment review pilot project recently launched by CMS
As part of its efforts to cut improper payments, the Centers for Medicare and Medicaid Services (CMS) has launched a three-year Recovery Audit program prepayment review demonstration project in 11 states. -
Discharge planning is CMS' focus
As the Centers for Medicare and Medicaid Services (CMS) continue to increase its focus on discharge planning, case managers need to pay more attention than ever to ensuring that patients have the information they need to make informed choices about their discharge destination, says Jackie Birmingham, RN, MSN, MS, nurse educator/consultant in discharge planning and vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm. -
ED Navigators prevent unnecessary admissions
By identifying community resources for homeless and near-homeless patients, Montefiore Medical Center in the Bronx, NY, is cutting down preventable admissions. -
Visits keep frail elderly out of hospital
Frail elderly patients are able to stay in their homes, thanks to home visits by an interdisciplinary team from Boston University's Geriatric Service at Boston Medical Center. -
Project reviews admissions up front
As part of the efforts to ensure that admissions are appropriate, Covenant Health System, with headquarters in Knoxville, TN, is conducting a pilot project to test the effectiveness of having utilization managers review patients admitted to the hospital, and work with the admitting physician to decide whether the patient should be admitted or receive observation services as an outpatient. -
Case Management Insider
In the last two issues of Case Management Insider, we reviewed the roles and functions most often associated with the work of case managers in the acute care setting.