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This program will provide a foundation of knowledge and understanding of the DRG system used as the structure for reimbursement under the Medicare and Medicaid programs. Included in this will be a review of the DRG relative weights, case mix index and expected lengths of stay. Medical record coding will be explained in the context of how hospitals get reimbursed. This will be followed by a discussion of managed care and managed care contracting as well as the various managed care products currently on the market. Also included will be a discussion on bundled payments and what case management professionals need to know in order to assist their organizations in controlling cost and length of stay in a bundled payment environment where patients may access care and use resources at any touch point on the continuum. A review of the state of the art in case management from both the acute care and community sides will also be discussed as well as the emerging trends that correlate directly with changes in health care reimbursement over time.
|- Healthcare industry today||- Mandate for change||- Medicare|
|- Medicaid||- Managed care definition||- Managed care contracting|
|- Managed care products||- The history of case management||- The evolution of case management|
|- Acute care case management||- Community based case management||And more!|
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