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The world of Healthcare is changing rapidly and so is the role of case management in that world! Whether you are reading or hearing about value-based reimbursement, the Affordable Care Act, the continuum of care, bundled payments, transitions in care, or accountable care organizations, case management is at the center of it all!
Because things like reimbursements, utilization management, transitional planning and compliance are changing so rapidly it can be a challenge to stay current and knowledgeable in the issues that most greatly impact your role as a case manager. CMS has incorporated changes that impact on payments related to re-admissions, length of stay and the cost of care. How do you as a case manager measure your impact on the cost and quality of care and the reimbursement your organization receives for that care?
All these topics and more will be covered in this jam-packed five-part series. Whether you are new to case management or a seasoned pro join us for our 5 part Boot Camp series. Read over the below summary detailing each episode and purchase your bundle today!
Episode 1 reviews the history of health care reimbursement and its relationship to case management. Included within the course is payment methods for Medicare and commercial payers and how this relates to case management for today and in the future. Case management professionals, including RNs and social workers need to understand the current payer systems and how they apply to their practice. This information is critical to success in their roles.
4/27/20 - Roles and Functions in Case Management - Who Does What and When?: Episode 2
As case management moved into acute care settings the roles and functions of both RN case managers began their evolution. From the time of the UR specialist sitting in the corner of a nursing station reviewing a record for medical necessity to appease the state physician review organization to the current role of the RN case manager involved in multidisciplinary collaboration, the roles have changed significantly. Additionally, case manager roles are transitioning across the continuum of care and are integrating through varied communication strategies. This program will review the contemporary roles of both RN case managers and social work case managers, in addition to clerical support and more complex case management roles, such as the complex discharge planner. Evaluate your roles and functions, as well as the roles and functions of your department in this informative seminar.
5/04/20 - Contemporary Case Management Models: Episode 3
Case management roles and functions evolved, so did case management models. From a model with social work support to a model without that critical support, case management leaders and hospital executives have been challenged to ensure a best practice model that lends itself to the most optimal outcomes. These outcomes are those that support both the hospital’s strategic plan and its revenue cycle. This webinar will discuss the varied models, including the currently considered model of moving utilization review out of the case manager’s hands, and in some cases, out of the case management department. As the models are reviewed, the opportunity will exist for the attendee to evaluate their model and determine if it is one that meets the need of their hospital, as value based reimbursement and other alternative payment models come in to play for all hospitals.
5/11/20 - Utilization Management: What Does it Really Mean? And Where Should it Reside?: Episode 4
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. This program will review the role of utilization management as it applies to today’s contemporary case management models. Included will be best-practice suggestions for your practice with tips and strategies for stream-lining the process and making it as efficient as it can be. Additionally, discussed with be the importance of utilization management collaboration in the case management role, whether it is housed with the RN case manager role or outside of it.
5/18/20 - Discharge and Transitional Planning Under The Current and New CMS Rules: Episode 5
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. Effective transitional plans can improve your hospital’s value based reimbursement. In addition, we will review how to engage other members of the interdisciplinary care team in the process of planning for the patient’s movement across the continuum including verbal and written hand-off communication. Transitional planning is no longer a destination but a process! Learn how to be certain that your processes address the complexities of the new healthcare environment.
CCMC: The Commission for Case Manager Certification certifies case managers and provides valuable continuing education credits for Case Management Advisor and Hospital Case Management. The CCMC is non-profit and the largest nationally accredited organization certifying case managers. The commission prides itself on promoting quality practice, ethical standards and behavior, science-based knowledge development, and raising awareness of the role of case managers
ANCC: Relias LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Contact hours [1.0] will be awarded to participants who meet the criteria for successful completion. California Board of Registered Nursing, Provider CEP#13791.
This CE activity is available for streaming on April 20th, 2020
This CE activity is valid until May 18th, 2023.