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Case managers are a hospital's first line of defense when it comes to smoothing transitions of care and preventing readmissions.
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As part of the ongoing education to prepare for Medicare's Recovery Audit Contractors (RAC) program, Cynthia Lawson, RN-BC, MBA, CPHQ, director of case management at North Hills (TX) Hospital is teaching her case management staff to think innovatively when reviewing charts.
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The Medicare Secondary Payer questionnaire is not complete. The Medicare number is missing from a replacement plan. The subscriber name or date of birth is a mismatch. An account has incorrect insurance coded for third-party liability.
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In preparation for the Recovery Audit Contractors (RACs) and to improve patient flow, Durham Regional Hospital redesigned its case management department and moved to a triad model of patient care.
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By redesigning its case management program and beefing up technology, Saint Thomas Health Services reduced the average length of stay systemwide by 0.20 days and saved more than $6 million in just two years.
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In an effort to ensure that the patients most vulnerable for readmission stay safe at home after discharge, Lutheran Medical Center is developing a pilot program with a local home care agency to provide at least one home care visit for the majority of congestive heart failure patients going home with no services.
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If you haven't started analyzing your hospital's readmission rates and the role case managers can play in reducing readmissions, it's time to start so your hospital can avoid penalties from the Centers for Medicare & Medicaid Services (CMS).
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The good news for home health providers is that as the numbers of patients seeking home care rises, so do the satisfaction levels reported by home health patients.
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All home health managers understand the importance of reviewing financial statements regularly, but are you correctly reporting payment variances? Are you using these variances as a way to uncover documentation or clinical issues that need to be addressed?
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Bayada Nurse's program that combines face-to-face education and remote monitoring of clinical information reduces hospitalizations for patients with congestive heart failure and hypertension.