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A clinical documentation review program at Jupiter (FL) Medical Center increased Medicare reimbursement by $278,000 the first year for the 156-bed community hospital.
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Working for 10 years as emergency department nursing manager at St. Mary's Hospital in Tucson, AZ, Cassandra Pundt, RN, CEN, recalls she was constantly struck by the "tremendous need" for a patient advocate specifically dedicated to the ED.
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It's frustrating when you point out that a patient doesn't meet acute care criteria or that documentation in a chart is not complete and nothing happens, even if you take it to your physician advisor.
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Remember that the case manager-physician relationship is like a marriage and you have to keep working at it to make it a good one, says Steve Blau, MBA, MSW, LCSW-C, director of case management for Good Samaritan Hospital in Baltimore.
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When it comes to talking with physicians about documentation or admissions criteria, it's often not what you say but how you say it that helps you get an answer.
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Self-pay emergency department patients who have no primary care provider are being referred to a nearby primary care and specialty center under a program in place at St. Mary's Hospital in Tucson, AZ, part of the Carondelet Health Network.
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Communication between hospitals and the primary care providers in the community is essential in managing the care of the uninsured, asserts Diana Resnik, vice president of community care for Seton Healthcare Network in Austin, TX.
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In September 1999, INTEGRIS Health asked 10 employees from their two Oklahoma City hospitals, INTEGRIS Southwest Medical Center (ISMC) and INTEGRIS Baptist Medical Center (IBMC), to redesign certain elements of admitting, case management, medical records, and billing practices.
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Higher patient copays and increasing numbers of people who are working but not insured have made the management of self-pay accounts a more crucial issue than ever for most of the nations hospitals.