Product Details

 

Purchase Value-Based Reimbursement Series to SAVE 19% 

In a value-based reimbursement environment, the utilization management (UM) process is critical to ensure cost effective care. UM must be a collaborative initiative, incorporating the case management department with physicians, nurses, and other ancillary departments. This program will focus on the role of UM in a value-based reimbursement environment, and review UM in today’s contemporary case management models.

Our experts will discuss best-practices for your work when providing the UM process in a hybrid environment, like UM for bundled payment patients versus the traditional commercial patient. Attendees will also be provided with tips and strategies for streamlining the UM process.

Do you have a utilization management process in place?

 After this webinar participants will be able to:

1. Describe the utilization management process to ensure payment in value-based reimbursement.
2. Identify ways in which the utilization management process can improve reimbursement when there is no denial process.
3. Discuss utilization management in contemporary case management models.

Covered Topics:

- UM case management roles	- UM Regulations	- Value-based reimbursement UM
- Critical case manager roles	- Hybrid case management role	- Collaborative process
- CoPs	- 2 Midnight rule	- UM committee
- Post-acute care providers	- Observation service	- Nursing & ancillary service
- Alternative payment models	- Transitional Medicare UM	- Appeals coordinator case manager
- Commercial UM	- Bundled payment	And there's more!

 

Toni Cesta, PhD, RN, FAAN is a founding partner of Case Management Concepts, LLC. Dr. Cesta is the author of eight books, a frequently sought-after speaker, lecturer and consultant and is considered one of the primary thought leaders in the field of Case Management. Dr. Cesta also writes a monthly column called Case Management Insider in AHC Media’s Hospital Case Management newsletter. She has been active in the research and development of Case Management for over 20 years.

 

Beverly Cunningham, MS, RN is a founding partner of Case Management Concepts, LLC.  She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.