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.
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.
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.
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.
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.
At New York Hospital Queens, a series of multidisciplinary, hospitalwide initiatives helped the hospital cut its length of stay by almost a day, despite an increase in the number of patients.
Faced with almost 50% of its patient population receiving Medicare benefits, Berkshire Medical Center in Pittsfield, MA, took a proactive approach to comply with the revised Medicare regulation requiring hospitals to give patients the Important Notice from Medicare, informing them of their right to appeal their discharge.
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.
