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Brace yourself for Medicare's Recovery Audit Contractors

Now that the Centers for Medicare & Medicaid Services (CMS) is rolling out its Recovery Audit Contractors (RAC) project nationwide, it's more important than ever for case managers to make sure the medical record includes documentation that supports medical necessity for the services patients receive, experts say.

Throughput plan focuses on long-stay patients

In the first year of Saint Luke Hospital's initiative to improve throughput for long-stay patients, the length of stay for those patients dropped by 0.5 days and the number of avoidable days dropped from 160 in 2006 to 90 in 2007.

Community CMs get medical care for needy

Through a partnership with a community free clinic, a community case management program at Hoag Memorial Hospital Presbyterian in Newport Beach, CA, helps needy residents learn to negotiate the health care delivery system and get the care they need.

Critical Path Network: LOS project drops ED stay for low-risk chest pain patients

At the end of a project to improve throughput in the emergency department, the length of stay for patients with low-risk chest pain dropped from an average of more than 30 hours to an average of between 20 and 24 hours at two hospitals in the Sharp HealthCare system.

Critical Path Network: High-tech hospital gives staff more patient time

At Dublin (OH) Methodist Hospital, the clinical staff carry notebook computers into patient rooms, communicate through wireless communications badges, and rarely touch a piece of paper or a pencil in their every day work.

Access Management Quarterly: Script 'introducing' DPs aids in 'Message' delivery

Two new auditing processes and a script for "introducing" discharge planners to their patients are the latest innovations at Stevens Hospital in Edmunds, WA, part of its response to the revised "Important Message from Medicare" (IM).

Director creates script for use in bed control

At California Hospital Medical Center in Los Angeles "we never want [staff] to say, 'We do not have any beds,'" says Elizabeth Oliver, director for access care for the facility, which is part of Catholic Healthcare West (CHW).

Rule does not cover where patients can go

A fee schedule change affecting payment for ground ambulance charges under Section 414 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 provides increased payments for urban and rural services, adds an increased payment for ambulance transports originating in certain low-density population areas, and provides a 25% bonus on the mileage rate for ground transports of 51 miles or greater.

Patient Safety Alert Supplement

Hospital Case Management – April 1, 2008

April 1, 2008