Articles Tagged With:
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Hospital Standardizes Debriefing After Critical Events
The maternal and fetal medicine team at Sharp Grossmont Women’s Health Center, affiliated with Sharp Grossmont Hospital in La Mesa, CA, improved quality of care recently by implementing a standardized debriefing process for critical events.
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Patients Threatened by Gaps in Care When They Change Settings
Patient safety and quality of care are threatened when patients move from one setting to another, but there are strategies that can address those gaps in care.
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Revenue Cycle Team Optimizes Reimbursement
If a hospital doesn’t have a revenue cycle management committee, case managers can approach leadership and suggest that they propose that the hospital administration create a committee to review all contracts and denials.
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Large Caseloads Make Denial Prevention Difficult
Hospitals that pile task after task on case managers and assign them large caseloads are unlikely to effectively manage denials.
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Be Knowledgeable About Hospital’s Payer Contracts
To prevent denials, case managers must know the requirements of each individual payer. But at some hospitals, the finance and/or managed care departments don’t provide case management with the utilization review section of the contract where the rules are outlined.
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How to Avoid Four Types of Denials
Case managers must take a proactive approach to reducing the denial rate — and the best way to do it is to prevent the denial.
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Types of Case Manager Reviews
This chart shows the types of payer reviews case managers typically perform.
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When Managing Denials, the Best Defense Is a Good Offense
Denials represent a significant amount of lost revenue. Case managers should take an active role in preventing and managing denials.
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How Many Conduction Defects?
The ECG and long lead II rhythm strip in the figure with the article was obtained from a 58-year-old man who was admitted to the hospital with chest pain and weakness. How would you interpret the tracing? How many different types of conduction disturbances can you identify?
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Clinical Briefs
In this section: using diuretics in heart failure patients; sexual dysfunction in patients with diabetes; and treating subtle gastrointestinal symptoms.